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Balancing Act: TCM Approaches to Easing Rheumatoid Arthritis Discomfort

02 Feb 2024

By: Kang Ting Tan

Blog, Acupuncture, Article, Autoimmune Disease, General Health, Pain management, Physician KT 陈医师

Rheumatoid Arthritis (RA)  is a chronic inflammatory disorder that causes joint inflammation and pain. RA commonly affects the hands, knees, ankles and usually the same joint on both sides of the body. In some people, RA can affect other parts of the body as well such as skin, eyes, lungs, heart and circulatory system.  Unlike the wear-and-tear damage (degeneration) of osteoarthritis, RA is an autoimmune disease. The immune system mistakenly attacks the synovium, the lining of the membranes that surround the joints. The immune system considers the body’s own cells, particularly those in the synovium, as foreign invaders, leading to chronic inflammation. Synovium is the tissue lining around a joint that produces fluid to help the joint move smoothly. The chronic inflammation results in  red, warm, tender and painful swollen joints that can eventually cause bone erosion and joint deformity. In addition to the joints, RA can affect other organs in the body.  Rheumatoid factor (RF) is an antibody that is often present in the blood of individuals with rheumatoid arthritis. Its presence is one of the diagnostic markers for RA, but not everyone with RA has detectable levels of RF, and some people without RA may have elevated RF levels. The exact cause of RA remains unclear, but researchers believe that a combination of genetic and environmental factors plays a role in its development. It is thought that individuals with specific genetic predispositions may be more susceptible to RA, and certain environmental triggers can activate these genes. These triggers may include viral or bacterial infections, physical or emotional stress, or other external factors (for e.g. being constantly in a cold or humid environment). The reasons behind a higher prevalence of RA in women compared to men remain unclear, and the condition typically manifests during middle age (25-50 years old). The likelihood of developing RA is higher for individuals with a family history of the condition. Early stage of RA Often affect smaller joints (wrists , certain joints (particularly the 2nd and 4th finger) in the hand and feet ) first  Muscle aches or joint pain worsens during humid or rainy days Disease progression Affect other bigger joints like wrist, elbows, shoulders, hips, ankle and knee Joint pain and deformity affecting daily activities  Anemic  About 40% of people also experience symptoms that do not involve the joints.  The inflammation associated with RA can damage other parts of the body as well such as:  Eyes: Dry eyes, redness or sensitivity to light  Mouth: Dryness and chronic gum inflammation  Skin: Rheumatoid nodules near joints (formed due to the accumulation of inflammatory cells and fibrous tissue) Lungs: Chronic inflammation and scarring can lead to progressive shortness of breath How TCM views Rheumatoid arthritis  RA belongs to the category of “ 痹症,Bi Zheng” in Traditional Chinese medicine (TCM). 《素问·痹论》说:“风寒湿三气杂至,合而为痹也。” TCM believes that the pathogenesis of RA is related to external causes and internal causes. External cause: Wind, cold, heat and dampness pathogen Internal cause: Deficiency of qi, blood, spleen, liver and kidney RA etiology in TCM perspective  其人平素体虚或劳倦内伤过甚,腠理空疏,元气不足,导致风寒湿邪(或郁而化热,或风湿热邪)流注于关节。 Experiencing chronic over-exhaustion or having a weaker body constitution may make one more susceptible to the invasion of wind, cold, or dampness pathogens targeting the joints. Extended inflammation leads to the buildup of heat and dampness within the joints. 若反复发炎则诸邪内损,可损及肝脾肾,亦能深伏于骨关节,筋脉,而血停为瘀,湿凝成痰,然后痰热互结,最总导致关节中肿胀,僵硬变形,而关节周围发生结节,皮肤色素沉着。 In the TCM  framework, chronic inflammation has the potential to harm the liver, spleen, and kidneys over time. This persistent inflammatory state can lead to either blood stasis or heat dampness, eventually giving rise to symptoms like swollen and deformed joints, the formation of rheumatoid nodules, or discoloration of skin. TCM approach to treating RA TCM employs a holistic approach to health and often utilizes a combination of therapies to treat RA. RA are generally categorized into three stages based on factors such as the duration of the condition, the type of pathogen involved, and the individual’s body constitution. Herbal medication, acupuncture and dietary restrictions are common methods to treat and manage RA. 1.Initial stage (早期:Wind and cold dampness Type  风寒湿型)   Symptoms:  Shorter duration 病程短 Generally weaker body constitution 多体虚 Morning stiffness and joint pain , especially during cold, humid or rainy environment or emotional triggers 晨僵,痛处受寒或气候潮湿或情绪波动时加重 No redness or warm joints 患处不发热发红 Aversion to cold or heat 恶寒发热 Floating and tight pulse 脉浮紧或沉弦带紧 Herbal prescription commonly used: 麻黄加白术汤加减 (麻黄, 桂枝,炒白芍,炙甘草,炒白术,姜黄,鸡血藤,忍冬藤等。)  Common acupuncture points used 五虎穴  复原穴  三间穴 阴陵泉穴    2. Middle stage (中期: 久病化热伤阴型)   Symptoms: Pain in the hand and feet joints 四肢关节肿痛,僵硬 Morning stiffness worsens with inactivity 晨僵,屈伸不利 Other accompanying symptoms: Dry throat, heart palpitations, dizziness 咽干,心悸,眩晕 Tight, thin and fast pulse 脉弦细数 Herbal prescription commonly used: 桂枝芍药知母汤加减 (桂枝,白芍,炙甘草,知母,生石膏,白术,防风,生地,炮附子,石斛,姜黄,秦艽等。) Common acupuncture points used 五虎穴  复原穴  三叉三穴 四肢穴   3. Late stage (晚期: 肝肾气血亏虚,痰瘀痹阻型)   Symptoms: Chronic pain: persistent and intense joint pain 慢性疼痛,关节刺痛或僵直 Limited mobility 关节活动不利 Joint deformities: swelling, stiffness and changes in joint structure maybe more pronounced 关节变形 Rheumatoid nodules can be seen 可见类风湿结节 Decreased quality of life. Daily activities, social interactions, and mental well-being may be compromised. 生活素质变差。 Herbal prescription commonly used: 独活寄生汤合虎潜丸加减 (独活 桑寄生 秦艽 防风 黄芪 当归 生地黄 熟地黄 黄柏 知母 白薇 炒白芍 石斛 姜黄 淫羊藿 桂枝等。) Common acupuncture points used 五虎穴  复原穴  足三里穴 丰隆穴 太溪穴 Acupuncture is a traditional Chinese medicine practice that involves inserting thin needles into specific points on the body to stimulate energy flow and promote healing. Here are some potential ways acupuncture might help individuals with RA: Pain Relief: Acupuncture may help alleviate pain associated with rheumatoid arthritis. The insertion of needles at specific acupuncture points is thought to stimulate the release of endorphins, the body’s natural painkillers, which may contribute to pain relief. Inflammation Reduction: Some studies suggest that acupuncture may have anti-inflammatory effects. By modulating the immune system and reducing inflammation, acupuncture might contribute to the management of RA symptoms. Improved Joint Function: Acupuncture may help improve joint function and mobility in individuals with RA. By promoting better circulation and reducing muscle tension, acupuncture might have positive effects on the range of motion in affected joints. Dietary restrictions Reduce consumption of  Sugary Foods, Cold Drinks, and Beer Excessive sugar consumption is associated with inflammation, and some people may experience allergic reactions or increased joint pain as a result. Raw and Cold Foods  In TCM, foods that are considered “cold” and “damp” are thought to obstruct the flow of yang energy, potentially leading to discomfort or achy joints. Peanuts, chocolate, millet, yogurt, glutinous or dairy products These certain foods possible due to their amino acid content  (tyrosine, phenylalanine or tryptophan), may contribute to production of inflammatory factors such as prostaglandins, leukotrienoic acid or IgE antibodies, potentially worsening joint inflammation or causing pain relapse  Too much sour food such as  sour plum, vinegar or lemon.  Sour foods are generally considered to have a contracting and cooling nature and may worsen joint pain. One is encouraged to consume more Chinese barley (reduce dampness), black beans, green beans, yellow beans, soy products, chestnut or sesame, Chinese yam, carrot, blueberry or turmeric powders (antioxidant properties). Early diagnosis and treatment in the earlier stages of RA can help prevent or slow down the progression to late-stage complications. Regular medical monitoring and adjustments to treatment plans are crucial in managing the disease effectively. Individuals with late-stage RA may benefit from working closely with a rheumatologist, TCM physicians and other healthcare professionals to optimize their care and improve their quality of life. Note: Information provided is not a substitute for a physician or any form of medical care. Individual symptoms differ due to different body constitutions and diagnosis. One should consult a licensed TCM practitioner for accurate diagnosis and treatment. Prices exclude GST. ^Treatments are done by certain physicians only
The Integrative Approach of Traditional Chinese Medicine (TCM) and Reproductive Technology (i.e. IUI and IVF)

22 Jan 2024

By: Kang Ting Tan

Article, Acupuncture, Blog, Fertility, IVF, Physician KT 陈医师

Infertility, characterized by the inability to conceive after a year of active attempts, affects both men and women alike. Assisted Reproductive Technology (ART), such as Intrauterine Insemination (IUI) and In Vitro Fertilization (IVF), becomes a viable option when conventional methods fall short. However, the challenges of these fertility treatments, marked by stress and expenses, create high expectations for success. IUI is a fertility treatment involving placing sperm inside a woman’s uterus through a catheter by a gynaecologist to facilitate fertilisation. The goal is to improve the chances of fertilization by increasing the number of sperms (by giving them a “shortcut”) that reach the fallopian tubes during ovulation and thus increase the chances of pregnancy. IVF refers to the fertilisation of an egg outside the body. During IVF, mature eggs are retrieved from ovaries and combined with sperm in the laboratory to achieve fertilisation. Then, the fertilised egg(s)/embryo(s) are transferred to a uterus.  Both are commonly used to improve the chances of pregnancy. Contrary to common belief, TCM, particularly acupuncture, proves to be a synergistic partner with modern medicine, enhancing the body’s condition and augmenting the success rates of IUI and IVF. Let’s understand conception first “Seed  and Soil” Analogy (种子论) Conception is like gardening and there are 3 basic requirements for fertilization to take place. Fertile, nutritious Soil  肥沃的土地–having a healthy developed uterus and endometrium lining and no “weeds” like cysts, endometriosis or fibroids that can affect implantation and growth  Seeds of life 种(zhong3)子 ( *种子必先育卵*) – Healthy egg and the sperm are crucial components for successful fertilization Time is key 对的时间点– Sperm and egg need to meet at the correct time and location, i.e. during ovulation (usually day 12-16 of the period cycle)  Age and its Impact on Fertility: For decades, the average marriage age has been in the 20s. However, getting married in the 30s may just be the new normal. Getting married later in life is a modern trend and hence affects reproductive and fertility status.  The optimal age for childbearing is between 20 and 35. The proportion of women aged 35 years and above who are intentionally delaying pregnancies has been rising in the past few years. Delayed pregnancies lead to an increased chance of infertility. Ovarian Reserve and Ageing: TCM acknowledges the natural reduction in ovarian reserve with age, emphasizing the correlation between age and declining fertility. Women are born with a fixed number of oocytes (eggs) inside their ovaries. 1 Age No of Eggs Puberty 300,000-500,000 20-30 100,000-300,000 30-40 10,000-50,000 40-50 1,000-10,000 50 (Menopause) 1000+ Ageing naturally reduces a woman’s ovarian reserve. The quantity and quality of a woman’s ovarian reserve declines with age. At the start of puberty, there can be 300,000- 500,000 eggs and it reduces to about 25,000 at around the age of 37. Male Infertility and Its Causes: On the other hand, male infertility is responsible for up to 30% of infertility. It can be caused by low sperm production, abnormal sperm function or blockages that prevent the delivery of sperm.  Sperm quality: low sperm count, poor sperm mobility, abnormally shaped sperm or no sperm present.  Varicoceles (enlarged veins in the scrotum) can negatively impacts testicular sperm production Obstruction of the vas deferens or epididymis (the tubes that carry sperm). Blockages can be a result of infection such as traumatic injury or gonorrhoea. Enhancing sperm count and quality involves adopting positive lifestyle changes. Consider the following measures: Stop smoking  Tobacco smoke contains more than 4000 kinds of chemicals, including nicotine, tar, carbon monoxide, polycyclic aromatic hydrocarbons and heavy metals. Smoking is associated with dysfunction of spermatogenesis and impaired spermatozoa function2, leading to reduced semen quality including semen volume, sperm mobility, sperm density and normal morphology.  Stop habitual heavy alcohol consumption  Alcohol can affect sperm mobility and alter sperm count, shape and mobility. In men, heavy drinking can lower testosterone, follicle stimulating hormone, and luteinizing hormone levels  and increase estrogen levels3. These hormone changes can reduce sperm production and development.  Have a  healthy diet rich in fruits, vegetables and whole grains.   Do not be a picky eater. You may be lacking zinc, Vitamin B, C or E. Zinc deficiency impedes spermatogenesis and causes sperm abnormalities4. Zinc cannot be stored in the body and hence regular dietary intake is essential. Vitamin C And E are essential antioxidants that protect the cells from damage from oxidative stress and free radicals.  Avoid excessive heat The normal physiological temperature of the human testis ranges between 32 and 35 °C. It is cooler than the core body temperature of 36.9°C. This is essential for optimal sperm production, maturity and function5. Hence, it is important to avoid potential heat exposure to the testicles such as prolonged hot baths, laptop, high-temperature work area and prolonged sitting. Avoid wearing tight pants too as it can affect the blood circulation to the testes.  Reasons for Choosing IUI and IVF: We recognize the various reasons (listed below), including cervical mucus conditions, ovulation disorders, and unexplained infertility, leading couples to opt for ART. Unexplained infertility Hostile cervical mucus condition Ovulation disorder Fallopian tube blockage or damage Impaired sperm production or function (poor sperm motility, count or quality) Ejaculation dysfunction Acupuncture’s Role in Enhancing IUI and IVF Success: Accepted Treatment for IUI and IVF: Acupuncture’s compatibility with Western medicine makes it a widely accepted form of treatment for ART. Optimizing the Body with Acupuncture: TCM’s acupuncture sessions, especially when initiated three months before IUI/IVF treatments, are highlighted for their role in conditioning the body for optimal success. This is especially so for those who have low ovarian reserve or poor egg quality.  Improving Sperm Quality: Acupuncture’s positive impact on reducing structural defects in sperm and enhancing quality, mobility, and concentration of sperm with normal morphology is emphasized6,7. As couples navigate the intricate journey of fertility treatments, the harmonious integration of Traditional Chinese Medicine, notably acupuncture, with modern reproductive technology emerges as a holistic and powerful strategy. This comprehensive approach not only enhances physical well-being but also addresses the emotional toll, providing a personalized path to fertility success. Embracing TCM alongside conventional treatments presents a well-rounded and supportive framework for individuals seeking to maximize their chances of conception. References: https://www.healthline.com/health/womens-health/how-many-eggs-does-a-woman-have#eggs-at-puberty https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4814952/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6761906/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6010824/ https://www.clevelandclinic.org/reproductiveresearchcenter/docs/publications/93_Durairajanayagam_et_al_Heat_Stress.pdf https://www.webmd.com/infertility-and-reproduction/news/20050803/acupuncture-may-improve-sperm-quality https://www.sciencedirect.com/science/article/pii/S2305050015000226
Exploring the Healing Art of Cupping: Techniques, Benefits, and Frequently Asked Questions

15 Jan 2024

By: Kang Ting Tan

Physician KT 陈医师, Article, Blog, General Health, Pain management

What is cupping? Cupping is a form of Traditional Chinese medicine (TCM) therapy that involves the placement or movement of glass, plastic or bamboo cups along our body’s meridian points to stimulate specific parts of the body. This increases surface micro perfusion which results in pain resolution. How does cupping work? “Where there’s stagnation, there will be pain. (不通则痛).  Remove the stagnation, and you remove the pain.” (通则不痛) Pain may be an indication of a possible stasis in your body.   The suction created causes the vasodilation (widening or opening up of blood vessels) of superficial capillaries. This promotes the movements of Qi and blood circulation of the stagnated area. Prolonged increment of vascular pressure leads to ruptured capillaries, which is reflected as the cupping marks. The degree of discoloration of the distinctive, circular “bruises” indicate the level of blood and Qi stagnation, toxin accumulation or dampness accumulation in your body. The darker the color, the more stasis present.  Cupping activates the lymphatic system to drain excess fluids and toxins. Anti-inflammatory substances are also drawn to the area. This promotes healing via increased local tissue metabolism, reduces local inflammation, muscle soreness, and enhances muscle recovery.  Cupping improves microcirculation of affected areas, promoting angiogenesis in tissues and cell repair, enhancing muscle strength.  Cupping restores the body’s natural flow of energy by clearing the stasis and hence relieves pain.  What are the different techniques of cupping? Flash cupping: involves quick, repeated and release of cups on the body to improve circulation Gliding cupping: gliding suction cups over after a specific meridian pathway or muscle groups after applying oil to enhance muscle relaxation  Stationary cupping: suction-only method. The cups placed on a specific area for 5 to 15 minutes to allow for deep muscle stimulation Wet/blood-letting cupping: To release stasis, toxins or edema on chronic problem areas Who is suitable for cupping ? Cupping is suitable for most patients except those who have certain conditions such as Sensitive or skin with ulcers, swelling, inflammation, infection or wound High fever or convulsions Bleeding disorder or on blood thinners such as warfarin Pregnant women (stomach, lower back, and specific points must be avoided)  Benefits of cupping from a TCM point of view Pain relief Relaxes stiff muscles  Remove blood stasis Expel cold-dampness Clear heat-toxins Facilitate the energy flow in meridian channels  Stress relief Combat fatigue  Boost immune system  Improve muscle endurance  Reduces DOMS* (Delayed onset muscle soreness)  *DOMS is the stiffness and pain felt in the muscles for many hours after a strenuous exercise  Frequently asked questions Cupping Marks and its colors’ meanings How long does the cupping marks take to go away? Light pink: fade within an hour Bright Red: fade between 3 days to a week Dark red/purplish red: up to 2 weeks  These marks will slowly fade and completely disappear after about 1-2 weeks depending on your skin’s regenerative ability. The marks will visibly be lighter and lighter and fade faster with regular cupping treatments  Please do let your TCM physicians know beforehand if you do not wish to have marks on certain areas. How often should I do cupping ?  It is recommended to do 1-2 times a week.  Are there any side effects from cupping? Though cupping marks resemble bruises,  it is often painless and does not involve tissue damage found in trauma-induced bruises.  Cupping is generally safe with no side effects.  However, some may experience dizziness or have sensitive skin around the treatment area. Hence, do not undergo cupping if you are too hungry, tired or thirsty.  Note: Information provided is not a substitute for a physician or any form of medical care. Individual symptoms differ due to different body constitutions and diagnosis. One should consult a licensed TCM practitioner for accurate diagnosis and treatment.