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.

Moxibustion Effectively Treats Perimenopause Symptoms – Lower Cancer Risk compared with HRT (Study)

Perimenopause is the transition that women go through on their way to menopause – the cessation of menstruation and fertility.   This transition can be a multi-year or even decade or longer process with the average being 4 years.  Some women will experience minimal symptoms and others can have years of problematic symptoms.  These symptoms are related to the lowering of estrogen levels as the ovaries reduce production throughout this process.  Symptoms run the gamut from mildly irregular cycles, occasional hot flashes and fatigue to more significant issues such as frequent spotting, very short and/or heavy cycles, increased PMS, changes in mood and/or libido and more.

One of the more common western treatments for perimenopause is birth control pills, but this can be problematic for some women and obviously problematic for those still interested in conceiving.  Other aspects of western treatment may be antidepressants, but obviously those are not dealing with the causes of the issues and only potentially help with a sub-set of issues.

A common form of western medical treatment in the 1960’s and 70’s was hormone replacement therapy (HRT), which is still used today.  In recent years, however, these treatments are used far more sparingly and cautiously after seeing increases in cancer rates and other health issues arise from treatment.  The issues potentially related to HRT are breast cancer, uterine cancer, bowel cancer, blood clots and/or stroke.  While bioidentical hormones are arguably an improved mechanism for hormonal treatment, there are no long term studies indicating any greater safety than standard treatments.  Either way, none of these treatments deal with your bodies ability to balance itself, which is the most positive outcome of treatment.

Acupuncture and Chinese Herbal Medicine have long been used to help treat a broad range of menstrual, hormonal and fertility issues.  Example Chinese Medicine diagnoses and treatment protocols related to menopause can be seen on our acupuncture for menopause page.  What you will see there is the range of more subtle diagnoses used to exploremoxibustion_roll_arm these symptoms vs. the western way of simply naming symptoms and doing baseline treatments that don’t always respect the true dynamic nature of each individual woman.  These more specific diagnoses are the crucial base of Chinese Medicine treatment.

There are techniques within Chinese Medicine that can be utilized with minimal education for certain conditions without a deep understanding of the clinical underpinnings of TCM that is required for acupuncture and proper Chinese herbal medicine treatment.  One of these techniques is acupressure, for example HT 6 for hot flashes.  Overall however, acupressure is somewhat limited in what you can accomplish for these range of symptoms.  Another commonly used technique is moxibustion (or “moxa”) – see “What Is Moxibustion?” for the basics.  Moxibustion is the technique utilized in the study I will present below.

Researchers from Shanghai Jiangwan Hospital and the Shanghai University of Traditional Chinese Medicine recently conducted a study evaluating the clinical effects of moxibustion on the range of chemical and hormonal underpinnings of perimenopause.  Utilizing 3 groups of perimenopausal rats, a control, a moxibustion treatment group, and a estrogen treatment group they began their exploration of the changes spawned on by the process of moxibustion.

The moxa treatment group received moxibustion at the following acupuncture points – 20 minutes daily for 6 days with 1 rest day.

  • CV 4 –  found in the lower abdomen a couple body inches (“2 cun“) up from the pubic symphysis, it is one of the more tonifying points for the kidney system (see “My Kidneys are What?“) which is functionally the foundation of the hormonal and fertility systems in western terms.  It is used for nearly all kidney system diagnoses in Chinese Medicine including kidney yin deficiency and kidney yang deficiency as well as generally tonifying blood (xue) and qi.  Can be used for a range of symptoms including most fertility issues, amenorrhea, fatigue, nightsweats, hot flashes and more.
  • ub_meridian_18-26UB 23 – found 1.5 cun lateral to the 2nd lumbar vertebrae (or GV 4), it is what is known as the kidney shu point (generally important points for their named systems).  Similar in broad function to CV 4, bladder 23 is used for a range of “kidney” system imbalances.  This includes such symptoms dysmenorrhea, amenorrhea, fertility issues, leukorrhea, overall systemic fatigue, etc.

The researchers found that moxibustion raised estrogen levels at similar levels to those with standard hormonal treatment.  The moxa group also had lower follicle stimulating hormone (FSH) levels, similar to the hormonal treatment group but with results seen in early stages of the study.  They also found that at 8 weeks in the moxibustion group there was a significant upregulating of estrogen receptors in the uterus.  Finally, they found that there were significant decreases in ovarian tissue death (apoptosis).

In essence the researchers found that moxibustion can stimulate the body to increase estrogen levels and protect itself from cell death.

Of importance here is that this effect is largely modulated by your bodies response to moxibustion, not by chemical interactions that happen with herbal medicine or other ways of treating these issues.  Clinically, in general, moxibustion has limited side effects when used properly as it is largely improving circulation and stimulating functions via certain acupuncture points.  The only potential downside of moxibustion is that in some over stimulated people (lots of heat signs, palpitations, anxiety – i.e. kidney yin deficiency) it may overheat and/or further stimulate them.  However, compared to what will happen with improperly prescribed Chinese herbal formulas (for example, stronger tonics such as you gui wan for kidney yin deficiency) the side effects would be minimal in most cases.

All in all, these responses are very interesting and help to deeply explain some of the beneficial effects of acupuncture and associated techniques such as moxibustion.  Further studies should be done to evaluate the clinical effects of needling those points vs. moxibustion, perhaps even acupressure.  All things considered, this is a simple technique to help your body restore its own hormonal levels without strong external intervention.  Along with proper acupuncture and/or herbal medicine treatment, moxibustion is a crucial part of easing perimenopausal issues, particularly in women who are still interested in becoming pregnant.

Get That Baby Out! – with acupressure… at home… (Study)

Acupuncture, which needs to be done by a properly trained and licensed acupuncturist, can help promote labor and ease labor delivery pain (it is also useful for a range of issues during pregnancy).  But in most cases acupuncturists do not do home visits, nor will they come to the hospital during your labor to assist.  In my practice we see most patients for labor induction when they call us out of the blue and tell us they are late and are trying to avoid being medically induced.

The acupuncture treatments we provide are very useful and effective – although for obvious reasons we try not to push things too much in our office.  Generally, most patients (95%+) will go into active labor 4 to 26 hours after their visit to our office.  This is fine, but the small percentage of patients that don’t go into labor could use more frequent treatment (1-2 times/day until they do go into labor).  This is often unfeasible unless you do home visits.

sp_meridian_5-7So what can you do alone to help promote labor?  There are thousands of folk remedies from nipple stimulation to eating eggplant and everything in between.  What works for one woman will be different for another and a lot of it is just having patience and trust in the natural process.  A recent study from medical researchers in Iran, however, confirmed one of our recommended acupressure points is helpful for cervical ripening and promoting labor.  This point, SP 6, is often part of most labor induction protocols and is easily stimulated by a loved one who is helping you through the process (or by yourself if need be).

Researchers recruited 150 woman with full term pregnancies that had been admitted to the hospital for delivery.  They divided them into 3 groups – one group a researcher performed the acupressure, another the mother herself performed it and the third group was a control receiving standard care.  SP 6 was stimulated about 20 minutes for 1-5 days and a variety of measurements were taken to see if the point promoted cervical ripening and labor.

They found that the point is a “safe technique and leads to cervical ripening”.  There were some differences between having someone do the point for you (better results initially) or doing it yourself.  After 96 hours, however, the results were similar.

So this is another tool that is easy to apply and has good clinical validity that you can add in with eggplant and squats and whatever else the thousands of mother ancestors will tell you worked for them.  During the birth of my son I was doing everything my wife asked me for with one arm and with the other was stimulating sp 6 to aid the process of both initial labor and during delivery (alternating with LV 3) and things went quite smoothly.

Generally these points do best, in my opinion, used more often for less time.  So just a few minutes 3-5 times a day when you are trying to promote labor.

Study Finds Infant Massage Can Lower Bilirubin Levels In Preterm Newborns

People are often surprised at the sheer range of conditions one may see as an acupuncturist. Further, many people are surprised to find out that acupuncture is but one part of a much larger system, Chinese Medicine, which includes herbal therapies, bodywork (tuina), and medical qi gong (energywork). Then there is the range of patients from 100 year olds to newborns…

Most acupuncturists in general practice will see children and infants with a variety of conditions. For many newborns you are not going to do acupuncture, but you will do massage or the system within Chinese Medicine called tuina (twee-na). Babies often heal and change quickly, compared with adults, and it is amazing at times what simple techniques can be used to create some powerful changes.

For premature babies, jaundice is common as their bodies cannot effectively excrete bilirubin. While jaundice appears in full term babies as well, premature babies will often be treated with lower bilirubin levels to avoid complications. These complications may include a variety of forms of brain damage, deafness, or cerebral palsy.

Researchers from the Shahid Hasheminejhad Hospital in Iran conducted a study evaluating the effect of massage therapy on bilirubin levels (jaundice) in premature babies. They evaluated 40 premature newborns in their NICU and divided them into two groups – one a massage therapy treatment group and the other a conventional treatment group. Conventional treatment is generally phototherapy (light therapy) until the bilirubin levels decrease.

The massage group received the same phototherapy treatment as the control group with the addition of two sessions of 20 minute massage daily. Researchers then measured bilirubin levels and bowel movements to evaluate the effectiveness of the massage therapy addition. They found a significant reduction in bilirubin levels and a significant increase in bowel movements in the treatment group vs. the control group. They conclude that “through massage therapy the bilirubin level in preterm newborns can be controlled and a need for phototherapy can also be delayed.”

The reasoning behind this change is not understood from this study. Perhaps it is a simple improvement in circulation, perhaps it just simply touch. Certainly there have been a number of studies looking at the importance of touch in infant development. This is probably a large part of the change recognized by this study.

Simple Acupressure Points Reduce Post Operative Pain and Nausea

Acupressure is often used for a wide range of mild to moderate conditions. One point that is often recommended is on the wrist and is often used for nausea – PC 6. Another point on the leg is used for digestive issues, strength and stamina and more – ST 36. Both of these points have been discussed in many studies before and have hundreds of years of clinical use backing them up.

A recent study from Taiwan published in the Complementary Therapies in Medicine journal, looked specifically at these two points and the effect on post-operative pain for gastric cancer patients.

Following gastric surgery pain, nausea and vomiting is common. The researchers here recruited 60 patients from a surgery center in Taiwan and randomnly assigned them to a control group and an acupressure group. Treatment was offered 3 days in a row, so this was only looking at immediate results in a post-operative setting.

They found significant results from the acupressure group in pain and nausea/vomiting scores and concluded that “acupressure is a simple, noninvasive, safe, and economical procedure for improving the comfort of patients who undergo surgery for gastric cancer. Acupressure at the P6 and ST36 acupoints can improve postoperative comfort by alleviating pain and decreasing the time until first flatus.”

Longer term studies should be done with more follow-up treatment to see if there are differences in healing speed and bowel function at the 3 month, 6 month and 1 year marks.

Leg and Feet Acupressure Points

Below you will find commonly used acupressure points located on the legs and feet.  Acupressure points on the legs and feet are used for a very wide range of conditions including digestive problems, stress and anxiety, insomnia, hot flashes, headaches, PMS, and more.  For acupressure points on other parts of the body, or for a general introduction to acupressure, please read the appropriate section:

Stomach (ST) 36

*On the Stomach meridian, located 3 cun below ST 35, one finger width lateral from the anterior border of the tibia. Generally found by sliding your 4 fingers together up your shin towards the knee stopping when your hand hits the knee. The point will be one finger width from the tibia on the outside of the leg just in line with the bottom of your pinky finger, pressing where it is most tender.

¤ Uses: anxiety, depression, low energy, leg pain, low immunity.

Spleen (SP) 6

sp_meridian_5-7On the Spleen meridian, located 3 cun directly above the tip of the medial malleoulus on the posterior border of the tibia.

Generally found by sliding your finger along the inside of the tibia up from the ankle about 4 fingers width and pressing where it most sore.

¤ Uses: stress, insomnia, anxiety, low energy. Do not use if pregnant.

Liver (LV) 3

lv_meridian_1-4On the Liver meridian, located on the dorsum of the foot in a depression distal to the junctions of the 1st and 2nd metatarsal bones. Generally found by sliding your finger in the depression between your big toe and the second toe until you are near where the tendons meet, then press where it is most sore.

¤ Uses: anger, irritability, stress, headaches, menstrual pain, anxiety.

Kidney (KD, KI) 1

ki_meridian_1-1On the Kidney meridian, located on your sole, in a depression with foot in plantar flexion, at the junction of the anterior 1/3 and posterior 2/3 of line connecting base of the 2nd and 3rd toes with the heel. Generally found by sliding your finger along the bottom of your foot between the big toe and the second toe falling into a depression slightly below the bottom of the big toe joint, pressing where it is most sore.

¤ Uses: insomnia, palpitations, anxiety, poor memory, hot flashes, night sweats.

  • Note: Acupuncture points are often located by the cun measurement, which is a relative measurement tool.
  • You can click on the point names below to find more information about the point and the meridian name to see a graphic of the meridian.
  • For particular conditions you can read our conditions treated section which offers some of the more commonly used points for a given condition.

Arm and Hand Acupressure Points

Below you will find commonly used acupressure points located on the arms and hands.  Acupressure on the arm and hand points aids a number of conditions including headaches, nausea, breathing problems, sinus issues, stress, anxiety and more.  For acupressure points on other parts of the body, or for a general introduction to acupressure, please read the appropriate section:

Lung (LU) 7

lu_meridian_7-10On the Lung meridian, located 1.5 cun above the wrist crease, superior to the styloid process of the radius. Generally found by sliding your finger from the thumb side of your wrist crease over the styloid process and press where sore.

¤ Uses: cold symptoms (sneezing, chills, runny nose), sore throat.

Lung (LU) 9

lu_meridian_7-10On the Lung meridian, located at the wrist crease on the radial side of the radial artery. Generally found by feeling the pulse in your wrist near the joint and moving your finger towards the thumb.

¤ Uses: cough, asthma, shortness of breath.

Percardium (PC) 3

pc_meridian_1-3On the Pericardium meridian, located on the transverse cubital crease on the ulnar side of the biceps brachii tendon.

Generally found on the elbow joint on the inside of the biceps tendon.

¤ Uses: stomach/digestion issues, anxiety, stuffiness in the chest.

Pericardium (PC) 6

pc_meridian_6-9On the Pericardium meridian, located 2 cun above the wrist crease between the tendons of palmaris longus and flexor carpi radialis. Generally found by sliding the finger lightly from the wrist crease between the two tendons in the middle of the arm until it stops and pressing where it is most sore. This is the point where the motion sickness bands are designed to stimulate.

¤ Uses: anxiety, motion sickness, insomnia, nausea, carpal tunnel syndrome.

Heart (HT) 7

ht_meridian_4-9On the Heart meridian, located at the wrist crease, on the radial side of the flexor carpi ulnaris tendon, between the ulna and the pisiform bones. Generally found by sliding your finger across your wrist crease from the thumb side towards the pinky side and stopping when you hit the bone and pressing where most tender.

¤ Uses: anxiety, insomnia, heart palpitations, depression.

Small Intestine (SI) 3

si_meridian_1-6On the Small Intestine meridian, located at the ulnar end of the distal palmar crease proximal to the 5th metacarpal phalangeal joint at the junction of the red & white skin. Generally found by sliding your finger along the outside of your hand towards your pinky finger stopping in the depression before you get to the pinky joint.

Uses: neck pain, headaches at the back of the head, earaches, ringing in the ears.

Large Intestine (LI) 4

li_meridian_1-5On the Large Intestine meridian, located in the middle of the 2nd metacarpal bone on the radial side. Generally found by sliding your finger from the joint of your index finger towards your wrist stopping in the depression where the thumb and the index finger bones meet and pressing where most tender.

¤ Uses: headaches in the front of the head, pain anywhere, cold symptoms such as runny nose, sneezing, etc. Do not use if pregnant.

Large Intestine (LI) 11

li_meridian_5-12On the Large Intestine meridian, located at the lateral end of the transverse cubital crease. Generally found by bending your elbow and looking for the sensitive point where the elbow crease ends on the outside of your arm.

¤ Uses: fever, arm/shoulder pain, diarrhea.

  • Note: Acupuncture points are often located by the cun measurement, which is a relative measurement tool.
  • You can click on the point names below to find more information about the point and the meridian name to see a graphic of the meridian.
  • For particular conditions you can read our conditions treated section which offers some of the more commonly used points for a given condition.