It is believed that the tendency to develop rheumatoid arthritis may be genetically inherited. It is also believed that certain infections caused by bacteria, fungi, or viruses (i.e. Epstein–Barr virus, parvovirus and bacteria such as Proteus and Mycoplasma) or environmental factors may trigger the activation of the immune system in susceptible individuals. Other risk factors include smoking, obesity, and in women, an adverse pregnancy outcome or never having children. It is more prevalent in female populations, which suggests a hormonal component. Factors supporting this hypothesis include the observed protective effect of the oral contraceptive pill, the increased risk in women who are nulliparous (never having given birth to a child), and the increased susceptibility to disease during the first three months postpartum. More research is needed on the role of hormones and genetics, but some of the risk factors for developing RA are preventable with proper health education and good choices.

Rheumatoid arthritis is characterized by inflammation of the same joints on both sides of the body, which results in progressive destruction of the joints and surrounding tissues. Often symptoms appear suddenly, and include tenderness and stiffness in the joints, early afternoon fatigue, low-grade fever, deformities and rheumatoid nodules.

Western medicine approaches treatment with rest and passive exercise until the inflammation is controlled. There are numerous pharmacological interventions. NSAIDs are generally the first option. Gold sodium thiomalate and penicillamine are used to block the inflammatory process. Hydroxychloropuine is an antimalarial medication that blocks inflammation by an unknown mechanism. Sulfasalazine blocks the activity of certain enzymes that release inflammatory compounds. Corticosterioids have dramatic short-term relief, but their benefit diminishes over time and they do not prevent the progressive destruction of the joints (see Acupuncture versus Cortisone Injection for the Treatment of Pain).

From a more natural perspective, it is important to take the diet into consideration, as there may be food allergies. Food allergies can cause inflammation in the gut which allows food particles to pass through the intestinal lining and into the blood stream, where they can travel all over the body and cause more inflammation. Vegetables in the nightshade family, including potatoes, peppers, and eggplant, are inflammatory and should be avoided. Plant and fish oils that are high in omega-3 fatty acids help control inflammation, as do carotenoids, which give fruits and vegetables their color.

Acupuncture has received wide spread attention for its ability to decrease pain. In fact, the proportion of chronic pain relieved by acupuncture is generally in the range of 55-85%. This compares favorably with that of potent drugs, such as morphine, which helps in 70% of cases, and far outweighs the placebo effect, which is demonstrated in about 30-35% of cases. (WHO; Acupuncture: Review and Analysis of Reports on Controlled Clinical Trials) However, since its therapeutic actions are achieved by mobilizing the patients’ own potential for healing, acupuncture does not produce adverse effects like many drug therapies. Instead, it is believed that acupuncture decreases pain by increasing endorphin levels, which block pain. This makes it an excellent treatment option, especially in chronic conditions, because most people do not want to take a pill for the rest of their life. In addition, drug interactions are potent causes of illness in our modern society, so keeping the number of medications to a minimum is a high priority.

Rheumatoid arthritis is referred to as Bi (Bee) Syndrome in Chinese Medicine. Most pain conditions fall into this syndrome, including osteoarthritis, rheumatic fever, gout and sciatica. ‘Bi’ means obstruction or blockage. Bi syndrome describes a set of syndromes in which the invasion of external pathogens such as Wind, Cold, Damp, and Heat obstruct the flow of energy and blood in the body. This affects the tendons, bones, muscles and joints, presenting symptoms of pain, soreness, heaviness, numbness, limited range of motion, redness or swelling. Depending on the symptom presentation, Bi syndrome will be classified as heat, cold, wind, or damp dominant. In heat dominant Bi, there will be more redness and burning. Cold dominant will present with limited range of motion with severe fixed pain that is alleviated by warmth. Wind dominant is primarily in the upper half of the body and presents with fairly mild pain that changes location. Damp dominant pain will usually feel heavy and swollen. Each of these will be aggravated by their respective environmental condition. For example, arthritis that is worse in the cold months is usually a Cold dominant Bi.

Acupuncture points, modalities, and Chinese herbs will be selected depending on which syndrome type predominates. If the diagnosis is Cold dominate Bi, moxibustion is an excellent choice. Moxibustion involves burning Mugwort, Artemisia Vulgaris, either directly on the skin or indirectly over acupuncture points. Doing so decreases inflammation by increasing white blood cell count in the area. Research by Xiao et al. (1992) has shown that moxibustion increases interleukin-2, an immune modulator, which in turn stimulates the proper functioning of the immune system. Thus, not only does acupuncture and moxibustion decrease pain, but they also treat the root cause of the pain, which in the case of RA, is a dysfunction of the immune system. Another study by Li et al. (2006) demonstrated a significant difference between a control group using methotrexate and NSAIDs to treat RA and a treatment group using the same protocol as the control group plus acupuncture and moxibustion. The effectiveness in the treatment group was 60% higher than the control group with less side effects. Thus, attempting to decrease the inflammation and subsequent pain by using natural methods before heading to pharmaceutical intervention is an excellent option.

In conclusion, the use of acupuncture and Chinese medicine is a viable option for people suffering from rheumatoid arthritis. Supporting the proper functioning of the immune system while decreasing inflammation will produce more lasting results than simply masking the pain with NSAIDs. In addition, a thorough health history and dietary education may provide insight for the patient on how their actions contribute to their health and vitality, thereby giving them the power to take their healing into their own hands.

Cortisol, a glucocorticoid, is a naturally occurring steroid hormone in our bodies that is secreted by the adrenal glands. Cortisol exerts a wide range of effects in the body that include regulation of metabolism, cardiovascular function, growth, and immunity. The amount in our blood stream is tightly regulated by the central nervous system. In a normal adult, in the absence of stress, 10-20 mg of cortisol is released daily and follows our circadian rhythm. It is commonly associated with the ‘fight or flight’ mechanism that helps us deal with stress. When we need to ‘run’ or make things happen quickly, cortisol is released and energy is shunted from our normal body processes to accommodate our quick actions. Thus, one could say that injecting cortisone mimics constant stress and will kick our bodies into the stress state unnecessarily. Glucocorticoids also increase glucose levels in the blood thus stimulating insulin release and inhibiting muscles from taking in glucose. This increase in insulin leads to a net increase in fat deposition combined with muscle starvation. Higher than normal amounts of glucocorticoids in the body leads to decreased muscle mass, weakness and osteoporosis. In children, it can retard growth.

On the flip side, cortisol can dramatically reduce inflammation. Simply put, it does this by cleaning up the mess that white blood cells make when they infiltrate an inflamed area. It also moderates the chemical messengers associated with the inflammatory response. Some of these same chemical messengers are involved in the immune response, thus cortisol decreases our immune response, which is helpful in organ transplants, but detrimental in preventing illness. In disorders where the inflammatory response is the cause of the major manifestation of the disease, cortisone injections may be helpful. However, in instances where the inflammatory and immune responses are important in controlling the pathological process, cortisone therapy may be dangerous and needs very close monitoring.

To summarize, the anti-inflammatory and immunosuppressive effects can be therapeutically useful, but are also responsible for some of their most serious side effects. For example, long term use suppresses the release of important hormones in our body. Large doses have been associated with peptic ulcers, fat redistribution, and can antagonize the effect of Vitamin D on calcium absorption. In addition, increased amounts of glucocortiocoids in the body often induce behavioral changes in humans, including insomnia, euphoria, and depression.

For cortisone injections specifically, the highest risks are for muscle atrophy and weakness and bone degeneration and these are more likely with more than one injection. Also, long term use will inhibit the bodies own production of these hormones and lead to syndromes associated with cortisol deficiencies. Since cortisone therapy in not usually a cure, the pathological process may continue to progress while the clinical manifestations are suppressed. Therefore, chronic therapy with glucocorticoids should be undertaken with great care and only for serious conditions. Kruse et al. (2008) reported that “the available research demonstrates a short term reduction in pain with corticosteroid injection and is indicated for patients who don’t respond to nonpharmecological or analgesic or NSAID treatment”. If it is decided that cortisone injection is the best form of treatment, certain diet modifications should be considered. These include an increase in dietary potassium and a decrease in sodium, caloric management, and a high protein intake.

A few of my patients have received cortisone injections. One patient had a complete resolution of symptoms for five years now. Another patient had a very bad flare up of pain for three days post injection with a moderate reduction in pain afterwards. A flare up is common after treatment, but often this is not discussed with the patient. Here is a link to patient discussions on their experience with cortisone injections.

Cortisone Injection – Describe Your Experience

So what role does acupuncture play in pain management? Acupuncture has received a lot of recognition as a viable alternative for pain management. As an acupuncturist, the mechanism of action makes sense when discussed in terms of Chinese theory. But these terms are difficult to translate into Western medical definitions and researchers have been working hard at demystifying acupuncture and how it works. A recent study published in the September issue of NeuroImage reported that acupuncture increases the binding availability of opiod centers in the brain that process and weaken pain signals. This will help strengthen the body’s ability to manage pain long term.

There are numerous other studies on different pain syndromes and how they respond to acupuncture, but there is still a need for more research. The National Institutes of Health generally recognize the efficacy of acupuncture in the treatment of low back pain and osteoarthritis of the knee. Since cortisone injections are used in the treatment of both of these conditions, it is reasonable to assume a course of acupuncture would be a viable alternative to the injections. In addition, the side effects of acupuncture are minimal and the other health benefits are numerous. Pain can cause sleeplessness, low energy, and poor mood, all of which can be treated with acupuncture while also treating the pain. This is due to acupuncture’s ability to open up areas that are blocked and congested, getting the energy that is naturally inherent in the body to move more freely, thereby decreasing pain and increasing energy and mood.

A normal course of treatment with acupuncture is between six to ten sessions. Most people will notice a decrease in their symptoms by the third treatment, some as early as the first. Symptoms may also change or move location with treatment. This is a good sign because it demonstrates your body is responsive to treatment. Once things begin to move, the blockages can be cleared and normal health restored.

Standing in front of the mirror in my bathroom, I scoped my throat with a flashlite, and to my absolute delight, discovered that I had blisters on my tonsils. That’s right – blisters! Something had to be done. I went to the local Chinese herbal apothecary and inquired about a substance I learned about in school for sore throats and canker sores – watermelon frost. The name invokes images of white icy watermelon slices and I had always been curious what the substance would actually look like and how it worked. It came in numerous forms, and each manufacturer added its own cocktail of other herbal ingredients. I chose the one with the most heat clearing antiviral herbs to unleash an herbal arsenal on my blistered throat.

Upon returning home and opening my bottle of watermelon frost, I discovered a green powder that can be used directly on cold sores of any kind. I mixed it with a small amount of water and gargled it. I did this every few hours and by the following day, my sore throat had substantially diminished and was completely gone after the second day! I was amazed at the speed at which it worked and so delighted to be able to swallow without whincing again. Thank goodness for watermelon frost!

The main ingredient, watermelon, is commonly used in China with every meal to cleanse the palate. Medicinically speaking, it is the quitessential summertime herb because it cools and moistens. It clears summerheat and generates fluids, resolves irritability, and stops thirst. One source text indicated it may also be used to ‘restore sobriety’ after over-consumption of alcohol. During the heat of the summer, in addition to keeping hydrated with water, watermelon is an excellent choice to optimize your water intake and keep your body cool.

A beautiful aspect of Chinese medicine is its frequent use of the Doctrine of Signatures in the classification of herbs. This particular herb fits quite nicely into this theory, which uses the color, shape, and common names of herbs to deduce what they might be used for. Goji berries are red, which would indicate their use in blood deficiencies. Frequently, herbs that are seeds or berries are thought to nourish the kidneys because in Chinese medical theory, it is the kidneys that are the source of our constitutional endowment. Just as a seed holds the genetic material to pass on to the next generation, it is believed that the kidneys are where this information is stored from our parents. The moist nature of the berry would imply a lubricating or cooling function, and it is said to nourish the yin, which can be understood as the liquid aspects of the body.

In Chinese herbal medicine, this herb is often added to formulas to support the body fluids associated with the liver and kidneys as a means of nourishing the eyes and reproductive organs, which the liver and kidneys govern. It can be used as a mild tonic over long periods of time without causing side effects, such as stagnation that can result from the cloying nature of moist and nourishing herbs. It is also used in Chinese dietary therapy as a long term tonic. Just add a handful to your trail mix, throw some on your morning cereal, or just munch on a handful through out the day. They are quite tasty! I have also been known to throw a handful in home baked cookies!

In Western terms, Goji berry stimulates the immune system, increases the production of red and white blood cells, lowers blood pressure, stimulates uterine contractions, and supresses the growth of cancer cells. It may not be a panacea, but it sure does have a lot of health benefits. I suggest high quality berries that can be found in health food stores or through reputable herb supply companies.

The Journal of Pain released a research study in July 2009 exploring the relationship between muscle trigger points and acupuncture points. Trigger points are areas of hypersensitivty in muscles that elicit tenderness upon palpation and are generally considered a common cause of pain. Frequently, palpating a trigger point causes pain to refer, move, or be felt radiating to another area of the body. The current research article attempted to overlay these trigger points and their areas of referred pain with acupuncture points and meridians. The authors concluded that “this article demonstrates that myofascial referred-pain data provide independent physiologic evidence of acupuncture meridians”. Thus validating what acupuncturists have known for centuries: that acupuncture meridians do exist! The authors also recognized that “understanding these meridians may enhance treatment of both pain and non-pain conditions”.

Diagnostically, as an acupuncturist, it is not uncommon that a patient will point directly to an acupuncture point when describing their pain. In addition, the general area in which their symptoms occur lies along specific acupuncture meridians. Interestingly, many times they will have other seemingly unrelated symptoms in other areas of the body and are surprised to discover that these other sites are linked to each other via acupuncture meridians. For example, a patient may complain about chronic pain on the front of their shoulder, along the large intestine meridian, and upon further investigation acknowledge problems with constipation or loose stools. By assessing the patients health status with careful questioning, acupuncturists can strategically chose acupuncture points to address multiple complaints at once.

This research article is an inspiring step in the right direction for the development of acupuncture research and a helpful tool to integrate such a powerful healing technique into mainstream health care.

See the abstract of this research article here:

Myofascial Referred Pain Data Provide Physiologic Evidence ofAcupuncture Meridians

Acupuncture has long been utilized as a general pain reduction method for thousands of years, originating in the Far East and gradually being utilized throughout the world. Effective cancer treatment often depends on the patient’s ability to not only defeat the cancer through various methods but to also maintain their health and mental spirit throughout the course of treatment.

Often, the symptoms and effects of the cancer itself on the body are insignificant compared to the pain and other side effects of chemotherapy and radiation. Patients undergoing chemotherapy and radiation are often fatigued, experience a lack of appetite and weight loss, and may become depressed. For cancer patients experiencing these and other side effects, acupuncture is extremely beneficial. According to the ancient theories of Chinese medicine, “qi,” or “life energy,” flows through energy channels within the body known as meridians. These channels connect the body’s internal organs, and if these meridians become “blocked,” or an individual’s qi cannot flow properly, disease will set in. Acupuncture is said to relieve blockages and restore the natural flow of qi, and ultimately restoring one’s health.

Cancers such as mesothelioma, which are often unable to be removed by surgical means, are often treated with some combination of chemotherapy and radiation [the combination of chemo drug Alimta® and anti-cancer drug Cisplatin® is a popular mesothelioma treatment method]. While these potent drugs can be effective in eliminating some of the tumor mass and growth, they also profoundly affect the health of the surrounding tissue. Symptoms experienced by those undergoing mainstream cancer treatments include fever, nausea, and debilitating pain.

Patients who undergo acupuncture in conjunction with mainstream cancer therapies have experienced dramatic reductions in pain and feel that their energy and mental wellbeing was restored. Cancer patients who feel energized, are pain-free and have a solid state of mind are more likely to withstand traditional methods of cancer treatment and have an increased survival rate.

Acupuncture is said to be so effective, in fact, that the World Health Organization [WHO] has recognized acupuncture as a successful intervention for adverse reactions to radiation and chemotherapy. The National Institute of Health [NIH] also agreed that acupuncture may relieve nausea and pain experienced by cancer sufferers, and the organization supports acupuncture clinical trials.

While this ancient method of therapy may be extremely effective for some, acupuncture may not be recommended for all cancer patients. Those who have a history of endocarditis, neutropenia or thrombocytopenia should not undergo acupuncture. Individuals with lymphedema or those who have a pacemaker should speak with a physician before beginning any course of acupuncture therapy.

While oncologists like Dr. Stephen Rush of the NYU Medical Center in New York, NY continue to work towards a cure, those who practice the ancient art of acupuncture will be working to help cancer sufferers experience a better quality of life and an increased rate of survival. And while the scientific validity of Acupuncture has been proved in many, many studies, the Medicinal Herbal Formulary of Chinese Medicine also shows promise as another resource for those suffering with various cancers, including asbestos cancer.

Jack Bleeker, Research Coordinator

August 1, 2009

Acupuncture meridians

Acupuncture meridians were initially detected through meditation. Sages who spent hours in quite solitude began to feel consistent pathways of energy running throughout their body. It was later understood that these pathways carry energy and blood and serve as a network that unifies all parts of the body. The meridians also connect the interior of the body with the exterior. Thus, an acupuncturist will use acupuncture points that lie on the surface of the skin to affect what is going on deep inside the body. There are twelve regular meridians, one for each organ, and eight extra meridians that have relationships with multiple organs and biological functions. In meridian theory, an obstruction or disharmony in one area of the meridian or in its pertaining organ can manifest anywhere along the pathway of that meridian. For example, because the Kidney meridian begins on the sole of the foot, foot pain may be attributed to a problem with the kidneys or to an obstruction elsewhere along the kidney meridian.

The meridians can be compared to rivers of energy and the acupuncture points like small pools or eddy’s where the energy collects and runs deeper. There are 365 acupuncture points that lie on the main meridians. There are also microsystems that mirror the entire body in a small area, such as in the ear, and trigger points in muscles that can effectively release muscle spasms. With the addition of these and other points, upwards of 2000 acupuncture points can be considered for use in treatment. They can powerfully open up blockages which have occurred in the body’s organ, muscle, and glandular systems. Each acupuncture point has defined therapeutic actions and points will be chosen depending on what kind of effect the acupuncturist desires to have on the energy of the patient.

Points are selected in combination and acupuncture needles are inserted into them, at varying depths, to reestablish balance within the body. Acupuncture needles are hair thin, sterile, and used only once. Each patient experiences the sensation from the needles differently. Some feel a dull ache behind the head of the needle, others feel tingling, warmth, movement, or no real sensation at all. And each acupuncture point can feel different. Occasionally, the points where the needles were may be tender, but this usually goes away within a few hours to a day. Some people are more sensitive to the needles and, as your acupuncturist, I will recognize this and meet you where you are at with patience and compassion. The amount of needles used per treatment varies and the length of time the needles are retained can be anywhere from 20 to 45 minutes or more. Most patients feel a deep sense of relaxation during and after the session, followed by increased energy, better sleep, and a general sense of well being that can last for days after treatment.

Most conditions require at least three treatments before a substantial difference will be perceived, but some see an alleviation of symptoms after the first session. A usual course of treatment is about six to ten sessions. In the beginning, treatments are scheduled once or twice a week for about a month, and then depending on your progress, more time can pass between treatments. Many patients schedule monthly ‘tune-ups’ to keep their body, mind, and spirit running optimaly and to ward off illness. As the old adage says, prevention is the best medicine.