Traditional Acupuncturist (BSc hons, LicAc, MBAcC, Dip Tui na)
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Archive for the ‘Sean’s View’ Category
No longer the centrepiece of embarrassing entertainment shows, hypnosis, or more accurately clinical hypnosis is emerging as a particularly potent form of medical treatment for a wide variety of problems and conditions. Already endorsed by the National Institute of Health and Clinical Excellence for the treatment of irritable bowel syndrome, and widely acknowledged in the medical community as a particularly powerful form of pain relief, clinical hypnotherapy can be a valuable method of inducing deep states of relaxation and rapidly shifting the way we think about the problems we can sometimes face in life. In common practice, it’s normal for a clinical hypnotherapist to treat clients for a wide variety of issues ranging from depression and anxiety, to phobias, weight control, exam nerves and much more.
Perhaps more than any other kind of therapy, hypnotherapy is one in which the relationship between the client and the practitioner is of prime importance. It takes trust and a sense of comfort and confidence on the part of the client in the qualities and potentials of the hypnotherapist for the experience to be as fruitful as possible, so good therapists in this modality are like gold dust and best sought out on the back of trusted recommendation.
One such therapist is my friend and colleague Hazel Gale. Hazel’s a clinical hypnotherapist in north east London as well as the two times world kickboxing champion and the current ABA (amateur boxing association) champion. When it comes to sports hypnosis her work is second to none and built on her skills not only as a top athlete herself, but also in her capacity to develop similar skills in her clients. She also however works brilliantly with a wide range of other issues aside from sports performance, and is my recommendation for anybody looking for a clinical hypnotherapist in London.
You can read about the results Hazel achieves with her clients here, or for the main page of her website visit:
You can also reach her by telephone on 07870 180 548, or via her clinic’s facebook page here
An article in today’s Guardian reports the conclusions of recent research showing that patients with lower back pain who had a 12 week course of yoga experienced greater mobility and pain relief than patients on current standard care. Benefits were also maintained even 9 months after the yoga was stopped, which could see yoga being recommended for patients with lower back pain and integrated into conventional care.
In the study, a group of 156 patients with chronic lower back pain were assigned to have the 75-minute yoga classes over 12 weeks, while a control group of 157 just saw their GPs. Participants filled in a 24-point questionnaire on whether their condition prevented them from doing everyday tasks. Those who did the yoga scored on average 2.17 points lower than those who did not. Three and nine months later, their scores were still 1.48 and 1.57 points lower respectively.
The National Institute of Health and Clinical Excellence (NICE) is the body in the UK which sets the guidelines on the recommendations for best treatment. Acupuncture for lower back pain is already recommended by NICE, and as a result I’m one of the acupuncturists working in conjunction with the NHS to deliver acupuncture to patients with chronic lower back pain through the Milton Keynes primary care trust pain clinic.
Yoga is something I frequently recommend to patients as an excellent practice for health, mental and physical well being, and physical flexibility, so it’s a great thing to see its benefits being more readily recognised through research.
The full story in The Guardian is here:
http://www.guardian.co.uk/science/2011/oct/31/yoga-lower-back-pain-treatments?fb=native&CMP=FBCNETTXT9038
Some of the best research and most knowledgeable insights in the field of acupuncture come from physiologist Thomas Lundeberg. It’s safe to say that he is perhaps the one scientist who has done the most research into the physiological mechanisms and effects of acupuncture, and his work is essential reading for anybody interested in a modern scientific interpretation of acupuncture as a treatment modality. I will be referring to many of his research papers on this blog and the one I’ll refer to today is a brief paper about gender differences among the acupuncture patient population.
It’s probably true that the majority of acupuncture clinics are populated by more women than men, and while there may be many socio psychological explanations for this, there appears to now be an increasing biological explanation too , and put simply it’s because women are in more pain, and possibly more biologically prone to it.
In this paper, Lundeberg et al refers to the fact that women are more likely to suffer from many painful syndromes such as fibromyalgia, temporomandibular dysfunction, migraine, rheumatoid arthritis and irritable bowel syndrome. While folk wisdom often posits women have better pain tolerance levels than men due to the frequency of menstrual pain and childbirth, it seems research is proving that women have lower pain tolerance levels not higher. In the paper there are references as to how women frequently score lower than men in pain tolerance scores, and how this is also borne out in animal studies too which show female rats being more sensitive to noxious stimulation than their male counterparts. There is also the fascinating observation that due to the hormonal fluctuations of the menstrual cycle, many clinical trials for medications don’t use as many women as it’s simpler to study men. Trials using animals will also frequently use only male rats for the same reasons. The natural and startling conclusion of this is that many women may be using medicine’s that are actually not fully studied for their own gender. Some rather complex biological differences in what could account for the difference in pain processing between the sexes are discussed, and overall the paper is an interesting reminder that clinical trials have many individual variances to consider if their conclusions are to be reliable – Individuality being something clinical trials have great difficulty in being inclusive of. As I’ll comment frequently, it simply isn’t possible to study optimal, individualised acupuncture in the context of a randomised controlled trial, but understanding how we might get as close to it as possible, or at least perceiving the barriers to it is a useful approach in understanding the virtues and limitations of how we gather information about acupuncture.
You can find Lundberg’s paper here:
In an interesting article published online in the New Scientist, writer Jo Marchant explores the evidence for looking at how our mental and emotional activity affects our physical health. While in Chinese medicine the mind body connection has been long established for thousands of years, it’s only relatively recently that western biomedicine has begun to escape the shackles of Descartes’ mistaken assertion that the two are separate, non interacting entities. Modern disciplines such as psychoneuroimmunology are showing us how our emotional life has distinct physiological correlates that impact not only the quality of our lives, but also their length.
In this brief video, and in the associated article, Jo quotes evidence that shows that optimism and positivity reduces circulating levels of stress hormones like cortisol, and that optimists not only recover better from medical procedures such as coronary bypass surgery but also live longer when suffering from conditions such as cancer, heart disease and kidney failure. In general they are noted to have significantly healthier immune systems.
You’ll also find some interesting facts that people who see themselves in a positive light have lower cardiovascular responses to stress and recover faster as well as having lower baseline cortisol levels. There are also references to some fascinating research that showed that students suffering from exam anxiety showed lower levels of adrenaline in their urine on exam day when they were given creative writing tasks before hand that focussed on their own positive qualities…All fascinating stuff, so read, watch, and perhaps consider for yourself what one thing could you do, that would positively impact how you view yourself and your life. Your organs will thank you for it.
Video: The healing power of the mind
Article: http://www.newscientist.com/article/mg21128271.700-heal-thyself-think-positive.html
Although the terms complementary and alternative are used often interchangeably without much significance I always think it useful to highlight the importance of acupuncture existing as a complement to conventional medicine and not a replacement or an alternative. In medicine, as is so often the case in many areas of life, it seems that too often people fragment into opposing camps and then find an opinion and stick to it resolutely. This happens frequently in medicine with very often people choosing a ‘conventional’ or an ‘alternative’ camp with rarely little objective crossover into seeing the relative virtues and limitations of both sides.
In the care of each patient as an individual, and bearing in mind the symptom is occurring in the context of a person, it seems the most important thing is giving the patient access to whatever treatment produces the most effective change in the safest possible way. As the maxim goes, ‘the medicine you need is the one that gets you better’. For different patients in different contexts, that medicine could be one of a number of different modalities, but initially in the treatment of illness a patients first port of call should be their GP to rule out any serious cause of illness that could be creating their symptom. Once this has been done then lots of options become available for how a patient might manage their problem. The strength of conventional medicine is its diagnosis and treatment of acute serious illness, where it can sometimes fall short is in the management of chronic illness, or the many cases of ‘functional’ illness when organically nothing wrong is found, but the patient is clearly not well and healthy. In recent years the reputation of complementary approaches (which far too often are categorised under the same banner) to healthcare has been damaged by the claims of some modalities of treatment, like homeopathy, to treat disease for which it has no possible means of treating (malaria for example). In this context neglecting conventional approaches has been dangerous and detrimental to patient well being.
If patients and practitioner in the care of the patients health both value a conventional diagnosis prior to anything else, then the safest route has been taken in addressing the problem, and a multitude of options can be explored. So in conclusion… let’s have less anti conventionalism and more of an integrated total approach.
Heiner Fruehauf is the Founding Professor of the School of Classical Chinese Medicine at the National College of Natural Medicine in Portland, Oregon. Having delved deeply into Traditional Chinese Medicine and completed post doctoral training in China, he’s a great source of information, particularly about Chinese Medicine as it was practised outside of the institutionalised settings of Chinese hospitals and universities. In this video he gives a fascinating insight into the weird and wonderful techniques of a traditional doctor in rural China (the interesting footage is about 2 minutes into the video). This video gives a brief glimpse of the doctor using emotional exercises for healing serious illness. It’s a fantastic insight into what traditional medical encounters might have looked like, and it’s interesting to contrast this level of engagement between doctor and patient in comparison to our own medical encounters in the west now. Although strange and intense, it’s a good example of how, in Chinese Medicine, our emotions are seen not only as key components of our illness, but also as key components of our recoveries.
Prospective patients should be relieved my own methods are a little more orthodox, don’t involve vomiting or wailing, and are considerably less draining!
Here’s to interesting viewing…
With an evolution exceeding well over 2000 years, acupuncture is a practice whose roots lie in cultural ideologies that are almost inconceivable to us now. In the 21st century we can best understand acupuncture (at least in terms of its physical delivery) as a technique of neuro humoral modulation, but this interpretation has only been possible through modern advances in understanding the body’s physiological mechanisms through science. For most of its history, acupuncture been couched in naturalistic, cryptic and seemingly mystical language; and while the rich metaphorical imagery of Chinese medicine is poetic, useful, and sufficient as a standalone way of delivering treatment, it does in a scientific epoch all too frequently garner misunderstanding, confusion and misinterpretation.
As such, some of the most interesting work developing in the field is the work done in reconceptualising acupuncture so that it can be understood in scientific terms. For me, this marriage of understanding both the benefits and the limitations of a traditional approach is an essential part in the ongoing evolution of acupuncture. Over the coming months I’ll be blogging and linking to some excellent resources that demonstrate the work going on in this area. Hopefully, this will illustrate how we now no longer need to refer to acupuncture solely in terms that are at odds with biomedicine, but rather in terms that are consistent with it.
The history of Acupuncture and Chinese Medicine
Acupuncture, which is one branch of Chinese medicine, has a very long history. The practice of needling patients for therapeutic benefit has existed for thousands of years and has descended through time periods and cultures in which ideas of health, illness and their causes differed drastically from our modern day perspective. Although there is no historical record of acupuncture needling before 90 years BC, the roots of Chinese medicine and early concepts of health and illness can be traced back to the Shang dynasty (1600BC – 1046BC).
Shang Dynasty medicine (1600BC – 1046BC)
In Shang dynasty culture there was only one possible cause of illness – injury from an ancestor. For us living in the 21st century this world view seems extraordinary, but in Shang dynasty China the dead were considered as real as the living and ancestors were seen to require constant propitiations and offerings. Failure to do so could end up in offending the ancestor which therefore resulted in illness. Although there was no medicine as such in this time period, divination was a common way of deeming the ‘will of the ancestors’ and the splitting of tortoise shells and the subsequent patterns of the cracking were reflections of their desires.
Over time, concepts of illness evolved from ancestor worship in the Shang dynasty to demonological medicine which came to prominence in the Chou Dynasty (1050BC – 256BC)
Chou/Zhou Dynasty Medicine (1050BC – 256BC)
While divination as practiced in the Shang dynasty continued into this era, communal attitudes to the apparent existence of the non living members of community changed. Ancestors were deemed less important in the intervention of one’s health and fortune, and there grew a greater emphasis on demons as the cause of illness – an interesting but no less strange development!
During cultural festivals exorcists would charge the streets of the community to thrust spears into the air in order to rid the town of its evil demons. This early theory that illness causing agents could be vanished through piercing and stabbing may have been the early origins of acupuncture. The Chinese character for healer also originated at this time and the character depicts a shaman (doctor) with a quiver and an arrow on the left, and a spear on the right. Thus we have the concept of the healer who heals through exorcism by piercing. (This is obviously not the modern day view of an acupuncturist!)
By the end of the 2nd century BC ideas on illness and health were evolving further. Medicine was moving away from the ideas of demons as the cause of illness and more toward nature and environment as sources of disease. At this time wind was seen to be a powerful component of illness and over time that evolved to include heat, damp, cold and dryness as well as various emotional states. Medicine was moving away from metaphysical assumptions about the cause of illness, to the realisation that man’s earthly and emotional environment may be more important in the patterns of his health.
The Huangdi Neijing
The Huangdi Neijing is a seminal text of Chinese medical practice and its formulation is dated at somewhere around the 2nd century BC. This text represents the first compendium of Chinese medicine as an organised practice and was strongly influenced by Confucianism at the time. It presents the theory of systematic correspondence which forms a cornerstone of Chinese medical thinking. The theory of systematic correspondence details an intricate network of relationships between physical organs, the emotions they affect and are affected by, and the environmental influences which contribute to the disease of the organs. Many schools of acupuncture base their practice on these theories but developed and expanded them in their own way.
The origins of acupuncture
The origins of acupuncture are actually not very clear but many theories abound. There appears to be a significant hazy period in the history of the evolution of acupuncture. The Huangdi Neijing makes an appearance somewhere around the 2nd century BC (although this is debated by historians) and is a highly organized text mentioning acupuncture practice, however very little other textual evidence of the use of acupuncture exists prior to this.
The most commonly accepted theory of the beginnings of acupuncture are that it evolved from boil lancing with perhaps some historical influence from the remnants of demonological medicine. One could propose that lancing boils not only served to visibly drain pathogenic substances from the body, but also that it stimulated endorphin release which contributed to the resolution of additional health problems as well as those connected to the boils. If lancing boils evidently drained illness from the body, it may have been the assumption that illness lying deeper within the body could also be extricated through methods of needling.
Finding an acupuncturist
When considering having acupuncture for the first time often the biggest considerations for prospective patients are firstly, how do you find an acupuncturist, and secondly which acupuncturist do you choose? While patients are often not aware of it, acupuncture is a very varied practice with many different styles, each with a different focus. This coupled with the fact that each acupuncture practitioner has their own distinct way of working mean that there is little in acupuncture that is homogenous. It really is a rich and varied therapy with each practitioner/style having their respective benefits.
The most important distinction for prospective patients to make is the one between western medical acupuncture and traditional acupuncture. Very often acupuncture is labelled and promoted under one banner but these two approaches are very different.
Western medical acupuncture is usually practiced by GP’s, physiotherapists and those with a conventional western medical training. They usually do very short courses (often just two weekends) and focus on using acupuncture to treat a small subset of complaints focussed mainly around muscular skeletal pain.
A traditional acupuncturist on the other hand is using acupuncture in the context of a more holistic perspective that is usually Chinese or Japanese in origin. Diagnosis is often more detailed, more comprehensive, and is aimed at bringing about positive change in not just the symptoms the patient experiences but also the patient themselves. Of the two styles, traditional acupuncture is more concerned with holistic change, with a strong focus on treating the person behind the complaint as well as the complaint itself. This is perhaps one of traditional acupuncture’s greatest facets.
When trying to find an acupuncturist, and then deciding on which acupuncturist to choose, here are some useful things to consider:
Is the practitioner a member of The British Acupuncture Council (BAcC)?
The British Acupuncture Council is the main governing body for the practice of traditional acupuncture in the UK. All members will have undergone a minimum of 3 years training, nowadays often to degree level, and will have qualified from an approved course. They are thoroughly schooled in traditional diagnosis, are educated in appropriate clean needle technique, and are required and committed to ongoing professional development. If you have treatment from these practitioners you can be sure their training has been a thorough one. They carry the initials MBAcC after their name.
Are they happy to talk to you before committing to treatment?
Most acupuncturists are very happy to discuss any questions you might have about the treatment itself and whether it’s appropriate for you. Before you begin treatment it can often be helpful to talk to the practitioner so that you can get answers for any questions you might have, these might involve what you could expect to experience with acupuncture, how much treatment you might need, and of course practicalities such as costs and treatment duration. If you don’t feel comfortable or happy to go ahead and book treatment, don’t. You can always speak to other acupuncturists, get a feel for them and choose whichever acupuncturist you feel most suits you.
What have you heard about them?
Skilled practitioners of any discipline have a good reputation behind them and word of mouth is often how practitioners and patients find each other. If you are considering treatment it’s often worth finding out if anybody you know has seen them and what they’re experience was like. This is always a useful place from which to begin, as is the British Acupuncture Council itself who’s website contains lots of useful information about acupuncture. You can find them by clicking here: www.acupuncture.org.uk
Many acupuncturists will have testimonials on their websites in which their patients have volunteered their comments on what their experience of being treated was like. Reading these is useful and will give you a sense of how the practitioner is, how they work, and whether they feel like the kind of practitioner you’d like to see.
If you’d like to see testimonials from patients who’ve had acupuncture with Sean, you can find them here:
http://www.seanheneghan.com/testimonials/
How does acupuncture work?
This is perhaps the most simple and natural question about acupuncture but it’s actually more complex than it might seem and the answer depends upon the perspective from which one is asking – there is acupuncture as conceived by the Chinese 2000 years ago, and there is acupuncture as conceived now by conventional medicine in the 21stcentury. In many ways the two can be seen to overlap and to communicate about the same thing, just in different language. This is the first of two articles exploring how acupuncture works, and here we will focus on the modern day conventional view.
What modern science has to say about acupuncture
Although it is still partial, there is now a good basic understanding of how acupuncture works – particularly in relation to its potential to reduce pain. The wider capabilities of acupuncture are not so well understood, and it is likely that there are additional mechanisms not yet discovered. The mechanisms that are understood can be categorised in the following way:
1) Local effects in the tissues surrounding the needle
2) Segmental effects affecting portions of the body supplied by common nerve pathways
3) Extra segmental effects occurring in the brain in the form of neuropeptide release
4) Central regulatory effects occurring throughout the whole human system.
Local effects in the tissues surrounding the needle
As soon as a needle is inserted into the body it begins to stimulate the nervous system. A nerve in response to being stimulated by a needle soon begins to release a chemical called calcitonin gene related peptide (CGRP). CGRP is a vasodilator which means it dilates blood vessels thereby increasing blood flow to the immediate area. This stimulates tissue repair and aids recovery.
Segmental effects affecting portions of the body supplied by common nerve pathways
At the same time as CGRP is being released, the stimulated nerve, in what’s known as an axon reflex, continues to propagate the stimulation up into a portion of the spinal cord called the dorsal horn. Here local cells release enkephalin which is a chemical that blocks further stimulation from the nerve. As nerves supply wide portions of the body a needle inserted in one area will hamper further stimulation from a wider area around it. This is termed segmental analgesia and an additional effect of it is to soften muscle tone in the area thereby dissipating tension. One could understand the action of enkephalin in the dorsal horn as the equivalent of a red light at a traffic light that halts the progress of further traffic i.e. it stops the progress of pain messages. As nerves supply and run off organs as well as muscles, acupuncture can help block pain messages coming from both.
Extra segmental effects occurring in the brain in the form of neuropeptide release
It is acupuncture’s effects in the brain that correspond to its capacities to effect change in a wide range of conditions.
Continuing up from the spinal cord the stimulated nerve propagates up and into the brain and across several portions of it. This in turn stimulates the production of:
ACTH (Adrenocorticotropic hormone) – a hormone which increases the production of corticosteroid thereby reducing inflammation
Endorphin – which further increases analgesia and promotes a sense of well being
Serotonin – which increases the further production of enkephalin, thereby reinforcing analgesia and feelings of wellness.
Noradrenaline – which further inhibits pain messages from the dorsal horn in the spinal cord
It is also hypothesised that oxytocin may be an important component in the sedating and calming effects that acupuncture induces, and also that the hypothalamo-pituitary ovarian axis is brought into balance by secretion of endorphin and ACTH. This mechanism may explain how acupuncture is able to regulate menstrual flow and duration and also to reduce the pain associated with the period.
Central regulatory effects occurring throughout the whole human system.
Once the axon reflex affects the brain it exerts an influence over the limbic system. The limbic system is the portion of the brain responsible for the affective component of illness as opposed to the sensory aspect of it, and when affected by acupuncture it typically reduces the sense of distress that pain and ill health can cause. An example would be experiencing a headache but with a reduced sense of distress that the pain might usually cause. It is this mechanism that could account for the sense that many patients get from acupuncture, which is the feeling of being happier, more relaxed, and more able to cope with life.
So to conclude our brief tour of the conventional perspective we can see that acupuncture produces inhibition of pain from peripheral nerve stimulation blocking pain messages from below, and induces the production of pain killing chemicals from above in the brain. This produces typical experiences of calmness and well being. In terms of the wider effects of acupuncture, this is thought to occur through various structures in the brain whose stimulation results in the production and secretion of a variety of different chemicals which exert widespread influence throughout the whole human system.
