Category Archives: Study

The Neuron Whisperer, Part I

OK OK – Not a cheesy post about psychic horse connection. BUT STILL… that is the look on my face when whispering to neurons.

The evidence is mounting that I am in fact, a Neuron Whisperer. I am prepared to back this up with a couple of solid peer-reviewed papers, as well as an anecdote, but I think that this clip from the Mighty Boosh sums up the idea the most effectively:

In this clip, tiny Howard and Vince’s white blood cells “crimp,” (parody of rap?) a synchronized rhyme which accesses memory and reflex simultaneously. They begin to re-enact the crimp, which helps them to recognize Howard as a friendly agent and to create further communication which can be propagated into the neural network. To the Brain!

You may remember a similar post using the Mighty Boosh’s “crimping” practice, when speaking about neural mirroring and group exercise, HERE.

Neural mirroring has been postulated as an evolutionary trait that allows us to learn extremely quickly via mimicry. It also allows us to function optimally in social settings by actually experiencing in our own minds the mental state of someone else by observing the physical manifestation of that mental state in another person. This is one definition of empathy. Here is a fantastic video by NOVA that explains neural mirroring (the transcript is a nice summary as well).

The concept of neural mirroring emphasizes the importance of having a medical provider who is in a good state of health and excellent state of mind and spirit. But acupuncture takes this a step further and directly impacts the function of the nervous system. In the video clip above, Howard is using a technique that resonates with how acupuncture communicates with the nervous system- by stimulating a previously used pathway (neurotransmitter release) in order to gain access to the deeper pathways of neural network function (neural repair, hypothalamic-limbic system access).

Acupuncture has been shown to promote nerve repair, in response to both traumatic injury (such as spinal cord damage or stroke) and neurodegenerative disease (such as Parkinson’s). One proposed mechanism of acupuncture’s action is the stimulation of the release of neurotransmitters such as endorphins and adenosine. The Mighty Boosh video should feature this adenosine molecule rather than white cells:

Or this beta-endorphin molecule (in the form of a beautifully tooled choker):

Acupuncture’s adenosine-releasing effect can treat many things, from pure pain relief to repairing nerve damage, reducing the severity of autoimmune disease, post-stroke recovery, and wound healing. Quite a laundry list of actions, there. I take this to mean that performing acupuncture (to release neurotransmitters such as adenosine) is a form of Neuron Whispering!

Monty Roberts, Horse Whisperer. KIND OF LIKE THIS! Except with NEURONS!

Part 2 will outline the details of how specific acupuncture points have been proven to affect neural function, and we will discuss what the experience looks and feels like in a clinical setting. Until then, here are some academic papers to make all of you nerds happy.

Here is a note about acupuncture’s effect on neurotransmitters, addressed in a lecture given to the American Academy of Medical Acupuncture in 1999: “Acupuncture can speed up the wound healing process92 and cause an exaggerated systemic wound healing and stress response.93,94 The response can include excessive release of endorphin, which stimulates epithelial cell growth,95 as well as analgesia. Other neurohumoral factors induced by acupuncture such as serotonin96 and adrenocorticotropic (ACTH) hormone97 also have growth-control effects.98 (1)”

A 2010 article in Science Daily News goes into some detail regarding the most current research on acupuncture’s mechanism of action:

The research focuses on adenosine, a natural compound known for its role in regulating sleep, for its effects on the heart, and for its anti-inflammatory properties. But adenosine also acts as a natural painkiller, becoming active in the skin after an injury to inhibit nerve signals and ease pain in a way similar to lidocaine.

In the current study, scientists found that the chemical is also very active in deeper tissues affected by acupuncture. The Rochester researchers looked at the effects of acupuncture on the peripheral nervous system — the nerves in our body that aren’t part of the brain and spinal cord. The research complements a rich, established body of work showing that in the central nervous system, acupuncture creates signals that cause the brain to churn out natural pain-killing endorphins. (2, emphasis added)

An August 2012 study of sciatic nerve damage in mice has come to the conclusion that acupuncture could be used as “a complementary approach to stimulate intrinsic motor fibres regrowth properties in patients…This study demonstrates that electro-acupuncture exerts a positive influence on motor recovery and is efficient in the treatment of pain symptoms that develop during target re-innervation.(3)” In attempting to understand the mechanism of this beneficial effect, the authors posit an association with the opioid-releasing effect of acupuncture as helping stimulate nerve repair, citing a 2007 study published in Brain Research that finds “that morphine may promote the regeneration and synaptic reconstruction of the terminals of injured primary unmyelinated afferent fibers in lamina II of spinal cord, by a process mediated by mu-opioid receptors.(4)”

A 2004 pilot study published in Neurorehabilitation and Neural Repair examined 36 cases of post-stroke motor recovery using acupuncture, and found that specific sensorimotor functions were significantly improved compared to the control group, based on a number of possibly combined mechanisms of action:

Acupuncture may provide a form of sensory stimulation that stimulates polymodaltype receptors providing a source of peripheral afferent stimulation via the spinal cord to central nervous system structures.11-13 After stroke, acupuncture has been found to induce changes in regional cerebral blood flow (rCBF) that may increase flow to hypoperfused areas of the ischemic penumbra.14 Changes in rCBF have also been attributed to acupuncture in the hypothalamus- limbic systems in response to stimulation of analgesic points, providing further support for localized cortical effects attributable to acupuncture stimulation.15,16 Additionally, stroke recovery has also been associated with neurotrophic factors that are capable of supporting neuronal survival after stroke.17 Recent animal work is beginning to demonstrate that acupuncture can enhance neurotrophic factor expression that promotes cell survival and prevents apoptosis.18-20 If the mechanism of acupuncture effectiveness after stroke is related to factors that influence afferent inputs and intrinsic cortical circuits associated with sensorimotor function, then measures of acupuncture effectiveness should be used that are more closely related to neurorecovery.(5)

And finally, to glorify the adenosine molecule to greater heights, I include the following 2008 study which examines the possible use of adenosine in inflammatory and immune pathways.

The effect of adenosine on cytokine production by macrophages has attracted considerable attention, because macrophage-derived cytokines are crucial initiators and orchestrators of immune responses. As tumour necrosis factor-? (TNF-?) was one of the first cytokines to be discovered, a substantial body of information has accumulated regarding the ability of adenosine receptor activation to limit TNF-? production following macrophage activation.

…Although A2A receptors are present on immature dendritic cells, they are expressed at low levels and appear to be silent, as their activation is unable to elicit downstream signalling events such as accumulation of intracellular cAMP25. However, dendritic cell maturation is accompanied by the emergence of A2A-receptor-mediated signalling responses, owing to both increased expression and coupling of A2A receptors25,26. A2A receptor activation on mature dendritic cells shifts their cytokine profile from a pro-inflammatory to an anti-inflammatory one, with reduced IL12, IL6 and interferon-? (IFN-?) production and augmented IL10 production2527. It is likely that dendritic cells in the presence of adenosine have a reduced capacity to induce T helper 1 (TH1) cell versus TH2 cell polarization of naive CD4+ cells27. This is due to the adenosine-induced switch in dendritic cell cytokine production away from the TH1-inducing IL12 towards the TH2-inducing IL10.

In summary, the available data support a dual role for adenosine in dictating dendritic cell function. Adenosine promotes the recruitment of immature dendritic cells to sites of inflammation and injury via A1 or A3 receptors. At these sites adenosine produces, via A2A receptors, an anti-inflammatory dendritic cell phenotype driving T-cell responses towards a TH2 profile.(6, emphasis added)

Acupuncture’s effect on the nervous system has been shown to elevate mood and relieve stress (an increasingly popular conception of acupuncture), but apparently this just scratches the surface. Acupuncture also helps regenerate nerve cells, helps perfuse injured brain tissue with beneficial blood for post-stroke recovery, initiates a strong anti-inflammatory effect and relieves symptoms of autoimmune diseases while strengthening the immune system against attack from outside forces.

Wait, wait… here is a picture of me, ACTUALLY NEURON-WHISPERING A HORSE!

Well, maybe we don’t have the most soulful connection, YET. These things take time.

And for your gratuitous viewing pleasure, a riveting TED talk about the process of having a stroke, as experienced and recounted by a brain researcher!

References:

1. Shang, Charles MD. MECHANISM OF ACUPUNCTURE – BEYOND NEUROHUMORAL THEORY; Lecture at the 1999 Annual Symposium of the American Academy of Medical Acupuncture.  Medical Acupuncture: A Journal For Physicians By Physicians. “Aurum Nostrum Non Est Aurum Vulgi” Fall 1999 / Wiinter 2000 Volume 11 / Number 2. http://www.medicalacupuncture.com/aama_marf/journal/vol11_2/conduct.html

2. Acupuncture’s Molecular Effects Pinned Down: New Insights Spur Effort to Boost Treatment’s Impact Significantly. ScienceDaily. 2010 May 31. http://www.sciencedaily.com/releases/2010/05/100530144021.htm (original article: http://www.nature.com/neuro/journal/v13/n7/full/nn.2562.html)

3. Ngoc S Hoang1,4, Chamroeun Sar1, Jean Valmier1,3, Victor Sieso1,2 and Frédérique Scamps1Electro-acupuncture on functional peripheral nerve regeneration in mice: a behavioural study. BMC Complementary and Alternative Medicine. 2012, 12:141 doi:10.1186/1472-6882-12-141 Published: 31 August 2012

4Zeng YSNie JHZhang WChen SJWu W.  Morphine acts via mu-opioid receptors to enhance spinal regeneration and synaptic reconstruction of primary afferent fibers injured by sciatic nerve crush. Brain Res. 2007 Jan 26;1130(1):108-13. Epub 2006 Dec 13. http://www.ncbi.nlm.nih.gov/portal/utils/pageresolver.fcgi?recordid=1354160406485082

5. David N. Alexander, Steven Cen, Katherine J. Sullivan, Gitu Bhavnani, Xiuling Ma, Stanley P. Azen and ASAP Study. Effects of Acupuncture Treatment on Poststroke Motor Recovery and Physical Function: A Pilot Study.  Neurorehabilitation and Neural Repair. 2004; 18; 259. DOI: 10.1177/1545968304271568 http://nnr.sagepub.com/cgi/content/abstract/18/4/259

6. György Haskó,* Joel Linden, Bruce Cronstein,§ and Pál PacherAdenosine receptors: therapeutic aspects for inflammatory and immune diseases. Nat Rev Drug Discov. 2008 September; 7(9): 759–770.  doi:  10.1038/nrd2638 PMCID: PMC2568887 NIHMSID: NIHMS71616 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2568887/


Sunrise at Wat Pho and the Chetawon Thai Traditional School of Massage

Current Sunrise in Bangkok: 6:26am

Current Sunset in Bangkok: 6:28pm

This makes for a nearly perfect 12 hour and 2 minute day. It’s nice to be in the subtropics. Nice and Hot!

Last week I was able to take full advantage of these hours. The impetus: a series of yoga and Thai massage classes at the ancient learning center of healing/ famous temple grounds of Wat Pho and the Chetawon School of Traditional Thai Medicine and Massage.

This school requires General Thai Massage as a prerequisite for more advanced courses such as Thai Medical Massage. The general course is 5 consecutive days, 9am-4pm. The medical massage course requires 5 weeks, 200 hours, and a stay in the dormitory at the school, the dorm part of which sounds interesting (kid again? simple monastic life?) and off-putting (I’m done with undergrad and have self discipline) simultaneously. I only have time for the five days course anyway, but I hope to find an advanced teacher and work individually with them in the future. For those of you curious about the experience of going to Thai Massage school in Bangkok, here is a rambling description of my experience here in the next two posts. I couldn’t resist the urge to describe some of the more banal details of life here in Bangkok, so please be easy on me!

SUNRISE in BANGKOK

5am. Groggily stamp out my alarm. Listen to the chorus of pre-dawn swallows and sparrows, and attempt to wake myself with their happy chirping. Mentally check my general phlegm level, which reflects the air quality over the course of the night- often the smog and smoke filters through my window in such a thick haze that I can taste it. Some days I bounce up with energy, and others my head feels like a watermelon stuffed with cotton! and phlegm! Spend 15-20 minutes drinking green tea, water with lime, or Nescafe (the instant coffee of choice here) and expelling said phlegm if necessary.

rising from mud in morning light

5:30am. Search my meager travel wardrobe to find temple-and-school-appropriate attire. This means my clothing should: cover the knees and shoulders, not reveal cleavage, and not be skin tight or a skirt. It must hold up against a good quantity of sweat and general discomfort during yoga outdoors at the temple, but have the added benefit of being warm enough to prevent me from getting cold shock as I receive treatments from classmates in the air-conditioned massage school room. This narrows my options to the advanced combination of t-shirt and traditional Thai fisherman pants, possibly with yoga pants underneath due to some inversion positions allowing the pants to fall UP the leg. I will eventually learn that loose slacks are preferred, since fisherman pants (so popular with foreigners) are a mild no-no in the temple due to their status as a lazy marriage between farmer attire and pajama pants. But they are so comfy! I then pack at least one change of shirt or even a second outfit, since after class I may venture into less holy venues downtown. Rather than go home and then come back through the intense Bangkok traffic to meet friends (easily taking an hour each way), I choose to stay downtown and carry two bulging bags of personal items. They come in handy for pushing my way through mobs of people on the sidewalk, but fare less favorably in nice restaurants or bars.

crowds, mostly polite

6:15am. Plan my transportation route downtown to Wat Pho. I could take a motorcycle taxi to the riverboat express, which would cost about 40 baht for the motorcycle and 10 baht for the riverboat, taking about 30-40 minutes. This option is exciting, and sometimes I’m in the mood for the adrenaline from the motorcycle ride (clinging to the back of a motorcycle taxi driver, with two large bags and long unwieldy foreigner legs that nearly scrape the ground at every turn and lean of the motorcycle which is actually more of a souped-up scooter as it weaves around traffic, onto sidewalks, past street dogs and through pothole-ridden alleys is definitely an adrenaline rush) and the not-so-fresh breeze from the ChaoPhraya Riverboat Express…Most days I instead take one regular taxi to the temple, for a cost of 70 baht and similar time frame. This cuts down on the number of steps involved and hence the number of chances for things to go wrong, which when given a moment’s chance in Bangkok they frequently do. ahem. The risks involved in cab rides are few but common: (1) driver nearly falls asleep at the wheel or has serious attention deficit due to very long working hours, frequently low blood sugar, and constant exposure to intensely nasty exhaust. (2) driver is completely manic or twitchy due to excess of energy drink consumption or use of amphetamines to counteract (1). (3) the cab itself stalls out at a stop light and will not start again, or the driver may need to work for a couple minutes to rev the engine back to life (letting loose a hydrocarboniferous plume of smoke into the cab and exacerbating (1), prompting (2)). (4) the cabbie determines that you are an ignorant foreigner and drives you in circles for a healthy half hour to run down the meter, if they are bored or especially pissed off at foreigners that day (see (2)). Luckily, knock on wood, I’ve only experienced 1-3 at mild levels so far.

Quick digression: The most recent cab driver I encountered on my morning ride to Wat Pho was a completely wonderful anomaly. The driver was A) female. My friends who live here say that they have encountered maybe two female cab drivers their whole life, but I have seen three in the past three weeks. Maybe I’m lucky (since the female cabbies have been nicer or calmer than their male counterparts so far), and maybe I just seem like I won’t hassle them for being female drivers. And although I am able to navigate by the skin of my teeth using rudimentary Thai, I am always thankful when the cab driver can B) speak very good English. I often initiate conversations in Thai, just saying hello and trying to be polite, and most taxi drivers just smile vaguely or give me a neutral business face. Occasionally they hold a halting conversation with me, mixed between Thai and English. Rarely they may ask questions in English and surprise me with a welcoming dialogue about Bangkok in general. The driver this morning spit a relative blue streak, and I now know that she is 45 years old, doesn’t have kids, has seven siblings, enjoys the country life but has to work in Bangkok, and that she C) HAS A PET SQUIRREL which was the first thing I saw as I entered the cab. It clutched onto her leg as she drove, in a calm yet alert squirrely manner. She purchased her pet squirrel when it was only one month old, at the famous, rambling Jatujak Market. She always has her ‘friend’ squirrel with her. It has bells attached to it somehow. I wanted to take a picture but I didn’t want to ruin the camaraderie that had developed over the half hour drive with a cheap touristy activity. ::end digression, and bulleted paragraphs::

Housed in Wat Pho: gigantic reclining Buddha head. The largest reclining Buddha statue in the world.

Wat Pho Temple Grounds, courtesy Photodharma.net

One of many gorgeous details of the temple grounds, in the courtyard of the Thai Massage pavilion at Wat Pho

7:30 am. Arrive at Wat Pho, a glorious temple with one of the largest temple grounds in Bangkok, and the largest reclining Buddha statue in the world. An article from the Thai-ASEAN News Network describes its importance in preserving knowledge such as traditional Thai medicine and poetry. It was the first university center in Thailand and was recognized by UNESCO in 2008 as a Memory of the World site. I am here to attempt yoga postures in a beautiful courtyard, surrounded by elegant carved figures of beautiful Thai people performing accurate poses for health and wisdom.

Apparently some poses call for a lesson in "sass" (see deer yogi)

Cat: disdain; Statue: eternal acceptance; Me: sweaty and awkward (not pictured)

8am. After soaking up the beauty and calm of the temple grounds, I am prepared to feel this glorious calm pervade my body in the form of yoga. The Thai Massage practitioners at the Wat Pho massage center lead a free yoga class every morning of the week. For half an hour, the heat and intensity of the temple’s reflective surfaces create a cleansing in the way accomplished by’hot yoga’ or a sauna. I alternate between focus, despair, physical pain, and occasional calm.

between 10-20 students every morning

not too shabby here

Oh this looks a little nicer

To the tune of “Sam, Song, Neung” (three, two, one) we hold various postures while early tourists pass by and sometimes join in, to our delight as they share in our discomfort. By the end of the half hour, we are all giggling and happy for the most part- others look washed out and tipsy from the heat- but we are all hugely thankful to this woman who brings ice-cold tea to revive us!

thank you!

8:30am. Totter back to the Chetawan School, through the back alley of the temple and past a gallery of street food vendors. Drink copious amounts of water and relax on the roof before class.

tourist vans getting ready to find their tourists.

morning corn!

view of Wat Pho from the roof of the massage school. the spires of the main four Cheda are striking.

9:00am. Class begins with a chanted prayer for the blessings of Jivaka Komarabhacca, “Father Doctor”, or Shivago. Not as in the Russian Doctor Shivago, but as in the personal physician of the Buddha who became famous throughout India, Tibet, China, and eventually Thailand, where he is recognized as having transmitted original knowledge of herbalism, of “Sen” or energy lines in the body, of therapeutic massage and more. He was a famous surgeon in his time, around 540 BCE. Legend in China tells that Dr. Jivaka was born with acupuncture needles in his hands, but acupuncture itself didn’t make it into the canon of Thai medical knowledge in the same way as energy pathways and therapeutic pressure massage.

Dr. Jivaka altar at the Thai Traditional Medicine Research Institute

Class schedule for the day consists of training from 9am-4pm, with two 10 minute breaks at 10:30 and 2:30, and an hour for lunch at noon. We are broken into groups based on which day we began class, since the school starts fresh courses for general massage every day of the week, in addition to several specialized courses such as Thai Medical Massage, Thai Herbal Medicine, and Pediatric Massage. My class consisted of myself and four other women, with two teachers at any time and sometimes three teachers. All the students of different levels work in the same giant room on the third floor, which is thankfully air conditioned. We are able to cram about 50-60 students and 20-30 teachers into this space every day.

White shirts are mainly teachers. They were a fun bunch!

Instruction style is completely hands-on. The teacher (or “Ajarn”) demonstrates a routine on the student while the other four work on each other and mirror the teacher. We all have a chance to mirror the teacher, and then we’re on our own, working from our notes and memory, prompted by the teachers to use correct stance and pressure.

Studying and practicing diligently

Details of treatment being explained

We pick up the general ‘routine’ quickly, since we practice it over and over, re-practicing the previous parts each time we add a new section. The whole Thai massage routine is one to two hours long, depending on speed and elaboration of some sections. We are taught contraindications and modifications for many aspects of the massage, based on the patient and the best technique for the practitioner’s body type. For my large “farang” (foreigner) body I have to modify some positions in order to put my body weight into the right place. Because of the huge range of body types of classmates and teachers, we get to practice changing the routine to fit the needs of the patient. I am impressed by the diversity of countries represented in classes as well- Japanese, Greek, Australian, South Korean, American, Spanish, many Thai, and a mixture of men and women (although more women than men).

parts of Thai massage involve perching like a bird or a large cat

The calendar in the background shows King Bhumibol of Thailand, who although was not proficient in Thai massage, did become a Buddhist priest.

Respectful teacher demonstrating correct technique

Our teachers have the most interesting attitude- while being respectful and making us feel completely safe and secure, they also have a jocular and relaxed, informal attitude born of many years of teaching a broad variety of people. Many have taught Thai massage for over two decades. They have a disarming and slightly discomfiting way of saying “eeeung” in a guttural and sometimes joyous low tone when we do something correctly, since it is the informal version of “ok, yes” in Thai. Other times, if our form is wrong they will say from afar, “aaaaah, ah ah mai?” (ack, no) until we correct ourselves or look at them in dismay and confusion. Then they take our offending limb or body part and move or push it to the correct place, firmly, sometimes gently patting, saying, “eeeung!” This applies to not only hands and feet, but also to thighs, backs and buttocks (which due to some posture alignment issues may be out of place)- so consequently there occurs a surprising yet oddly non-offensive version of butt and thigh smacking on the female teachers’ part. The males never touch the female students in that way, and maintain very clear boundaries, but the female teachers remind us to move our leg back with a pat to the thigh for example.

This is something that goes against all my professional training and would never be acceptable in the US, a detail like that, but it seems oddly effective in this setting, somehow prompting the nervous foreigners (many of whom had never given a massage before) to relax and remember that a body is a body, to be humble, and to paradoxically de-sexualize the experience by adding humor. The teacher is stating (in a kind rather than mean-spirited way) that the student must be humble and good-humored enough to realize that the safety and comfort of the patient is the most important thing, and to move quickly to change an incorrect posture. Because of the language barrier, this physical response is often necessary. Several teachers are physically there with us the whole time, ready to pounce the minute our form is wrong, providing not only a visual but also a tactile and audio reminder of where the correct movement should be. This also contributes to the fast learning necessary to be able to accurately perform an hour-long sequence of massage and stretching after 35 hours of instruction.

12pm. LUNCH! We are all dehydrated and very hungry by this point. I will end this particular post with some of the lunch spots near the school, and the next article will cover the conclusion of the course!

delicious cheesecake and pad thai

fantastic classmates!

a mom and pop noodle shop

more great classmates, hungry!