Tag Archives: acupuncture

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/


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An Acupuncture Nerd in Thailand

The Chao Phraya River, which cuts through the center of Bangkok

As many of you may know, I am now in Thailand, in Krung Thep (Bangkok), the City of Angels! Actually the name for this city in Thai is the longest place name in the world (courtesy “Web of Linguistic Fun“). The following should be all one word:

Krungthepmahanakon…- (the land of angels, the great city of)

bowornratanakosin- (immortality, various of divine gems)

mahintarayudyayamahadilopop- (the great angelic land unconquerable)

noparatanarajthaniburirom– (land of nine noble gems, the royal city, the pleasant capital)

udomrajniwesmahasatarn– (place of the grand royal palace)

amornpimarnavatarsatit– (forever land of angels and reincarnated spirits)

sakattiyavisanukamphrasit– (predestined and created by the highest devas). 

The translation here is pretty much the unabridged history of the city rather than a word.

I’m visiting this beautiful and exciting country partially for personal reasons and partially for work. Half of my family lives here, and I have benefited from their amazing generosity in the past and present, as they have taken time to show me around the temples and marketplaces of Bangkok, Chiang Mai, Hua Hin, and many other villages around Thailand. This is the first time that I have a purpose in coming here other than pure touristing. I am here to work with Yanhee Hospital in their Natural Medicine Department, to learn Thai Massage, and to learn as much as I can about Thai Herbalism and Acupuncture’s role in the hospital system here.

The green blur is the sign for Yanhee Hospital, which I can see from my balcony

Now before you google Yanhee and start making assumptions, no I am not getting plastic surgery or undergoing a sex reassignment surgery, although about 80% of Yanhee’s patients have medical procedures in those categories. Yanhee has a large natural medicine department, which is where I am spending my time.

Lots of cosmetic surgery options here.

This is more like it:

Physiotherapy will be my jam (not pictured)

A happy coincidence allowed me to begin working with Yanhee Hospital, which is only a 20 minute walk from my house.  I will write a more detailed blog post about the actual hospital and the procedures that I’m involved in, but basically I am helping with rehabilitating patients who have had a stroke or who have cerebral palsy.

I ‘ll be treating mainly Thai stroke patients in the physiotherapy dept

Meanwhile, I will be learning Thai Massage next week, and currently I am doing an informal survey of acupuncture clinics in Bangkok. The ways that acupuncture is used here are very interesting, because acupuncture was only recently legalized in Thailand in the year 2000. Prior to that, you could receive acupuncture in Chinatown and at Chinese hospitals, but they were kind of unofficial or had to pay the police more than usual to stay in operation. Now Thailand is making strides towards popularizing this therapy and taking it out of the realm of purely a Chinese pursuit or a Spa treatment for westerners. Here is an example of a clinic that uses a more integrative approach-

I am actually really in love with this clinic (AcuMedic) and I recently had an herbal consultation with an elderly Chinese doctor of acupuncture. The AcuMedic clinic began in London, with a famous Chinese practitioner who spent his college years in Britain and has since treated Princess Di and other celebrities in Britain… this is their first branch in Asia and it seems they are doing an excellent job and working with amazing Chinese practitioners. I will provide a longer post exclusively about this clinic in the future, but for now all I have to say is, I’m so excited about this clinic!

The focus on health is very strong here in Bangkok. However, as I’m enjoying some of the tastiest and healthiest street food in the world, many Thai children are flocking to KFC and Mister Donut for their more ‘modern’ snacks. The same old story of increased levels of diabetes and hypertension in children is being played out in Bangkok, with the same attendant backlash against junk food, which is followed by a renewed interest in traditional medicine and ‘green’ or ‘natural’ products. In really great news, Thailand is also formalizing the teaching and accreditation of Traditional Thai Medicine.

DELICIOUS fresh pomegranate juice!

Next week I will begin my training at the Wat Pho school of massage. This is the place to go for any foreigner interested in learning Thai Massage. I am taking the general massage course, which is a prerequisite for their more intensive (and expensive) Thai Medical Massage course, which is 26 days, five days a week for a month, 9am to 4pm. I will take that course eventually, but for now I am starting from the beginning! Wat Pho itself is a beautiful temple with extensive grounds, housing the famous huge reclining Buddha and many other significant Buddhas and meditation halls such as this one:

Wat Pho is full of astounding sights

Not only is natural medicine gaining attention here, but also local and sustainable products are finding a bigger market. As part of the renewed interest in ‘green’ and natural products, the One Tambon, One Product program (tambon means village), aka OTOP, was instituted by former prime minister Thaksin Shinawatra in the early 2000s. OTOP promotes locally crafted items, many of which fall into the herbal or healing category.

The way it works is that representatives of the OTOP program visited the villages all over Thailand and helped them focus on creating one product for commercial production, rather than having a bunch of products in each village made with less efficiency. Basically they started to specialize and centralize this kind of production- one village would just focus on making brooms, another on herbal liniments, another on the best naturally dyed cotton, etc. The royal family then makes a wholesale purchase of village products from all over Thailand, and they then disburse the products at local market outlets and large conventions. This initiative, combined with other creative ways that former prime minister Thaksin helped pull Thailand out of the economic slump of 1997 onwards, has been dubbed Thaksinomics.

I enjoy visiting the huge OTOP conventions, since it’s a way to learn about the handcrafted products of all the regions of Thailand in a day or two. I always come away with a higher respect for the knowledge, expertise, and craftsmanship of the vendors and village representatives that I meet. Again, since this is kind of an overview/update post, I will be detailing the types of products that I got at the OTOP fair (including Thai herbal textbooks, eep!) in a future post. I have a lot of writing to do!

at the 6th day of the OTOP fair, the decorative flowers had seen better days

So in the next couple days I will be doing lots of writing and cataloging. The past two times I visited Thailand, I took notes but not nearly enough. I hope to use this blog as both a way for you to join me on my journey and also to document the places I go/ people I meet so I can remember them next time I am here! Meanwhile I will eat lots of longan fruit and goji berries to improve my memory 🙂

Even through the mists of time, in general Thailand is exactly as I remembered it. My perspective is different this time since I am focusing on working as well as sight-seeing, and this has opened my eyes greatly. Coming from the dark, rainy Pacific Northwest, I welcomed the sensory stimulus, heat, vibrance, and of course the delicious food of Bangkok! I am reminded why the energy drink was invented here – the sound level, pollution, and general feeling of pulsating life tend to inhibit the completion of a restful night’s sleep, and everyone works incessantly.

The best Pad Thai in Bangkok

Luckily I have no problem falling asleep on an accelerating airplane, in a tree, or on a public bus (to my chagrin), so I don’t need to worry about insomnia at this point. But I have noticed that since arriving, my quality of sleep has diminished and I don’t wake up as refreshed… hence the espresso, ginseng, red bull, 5-hour energy drink, or for some the aid of illegal uppers such as yaa baa, or “crazy medicine” (hello overly energetic taxi driver!).

2am tuk-tuk ride

As I’m writing this, it is only 11pm and the city is just as alive as it was at 11am, but without the songs blasted over loudspeakers at nearby schoolyards or yelling children running across backyards. In their place, other sounds fill the night: the cheering and whistles of a soccer game played in a neighborhood square; a howling street (“soi”) dog setting off a cacophony of yowls and yips, growing exponentially to the point of making me question whether a dog-riot is about to coalesce and get all Animal Farm on the humans; the murmur and rush of wind sweeping heavy clouds from the tips of skyscrapers; the stuttering yet constant beeps, honks, and grunts of traffic amplified, thickened by the darkness so that sounds bounce like pinballs from one bright street to the next, careening through my window from miles away.

Chao Phraya River at night

It’s difficult to describe the atmosphere here, but these impressions are one way to begin to BEGIN to get a handle on the culture and daily life of Bangkok.

Coming here has given me an interesting perspective on my own position in the US and internationally. I have continually returned to many questions in the past week since I have arrived in Bangkok. What does the schooling for acupuncture in the US actually accomplish? How prepared am I to treat severe conditions? How do I communicate my level of expertise properly? What is my worth? Why is the TCM educational system in the US so unstandardized? Why don’t acupuncturists (many of whom also learn herbalism, work in student clinic for over a year, and ultimately learn a complete and effective system of diagnosis and treatment) earn the title of Doctor, as do chiropractors and naturopathic physicians?

First of all, I’d like to say that I am confident in both my knowledge base and my ability as an acupuncturist. However, the critical, pessimistic, analytical parts of my being must pick apart and reconstruct the experience of my schooling in order to clearly communicate my level of expertise with colleagues in other areas of medicine.

After being asked many times in Bangkok, “Are you a Doctor?” and being referred to as “Doctor Beth,” when nurses understand that I am an acupuncturist, I begin to seriously question whether I am a doctor, why I should care if I’m a doctor or not, and who creates the meaning of being a doctor- who gets to define this doctor idea. I’m sure I could find some amazing medical anthropology texts that dive straight to the bottom of this question (if you have any good ones, please send them my way!), but I’m not sure if anyone ever surfaces after taking that teleological plunge. The notion of doctor-hood digs at the roots of existence, of being, and of ethics, morality, and spirituality. But I am not concerned with going into that now- I would like a more practical approach.

To me, the question of ‘doctor-hood’ comes down to two things: diagnosis and treatment. Can you make an accurate diagnosis according to the guidelines of your diagnostic framework? Can you provide an effective treatment based on that diagnosis? Does the patient recover and experience a return to a state of health and autonomy?

In that regard, yes I am a doctor. Traditional Chinese Medicine (TCM) has given me a highly sophisticated diagnostic tool, after learning the basic principles of which I am prepared to treat any condition that comes my way. In my 1.5 years of practice (not to mention the whole 2,000 years of recorded clinical efficacy), this has been borne out in reality, as I have both the tools to successfully treat conditions that have been presented to me (using a combination of herbal prescription and acupuncture with its associated modalities), and the knowledge to identify when a referral is needed (to the E.R., to a specialist, etc.). Granted, I am no biochemist or surgeon, but I am not using pharmaceutical grade doses of substances nor am I intervening in critical conditions. Using a complex, inductive system of diagnosis, I and my colleagues have the skill to address many recalcitrant conditions for which allopathic medicine has been ineffective.

Yet with everything that Traditional Chinese Medicine (TCM) has to offer in terms of primary care and preventive care, TCM remains completely vague and ill-defined in the public eye and in our institutions in the US. Even the name itself is up for discussion, since we have to differentiate between Classical Chinese Medicine, Traditional Oriental Medicine, Traditional Chinese Medicine, Traditional East Asian Medicine, and I’m sure more names of which I am not aware. Nomenclature in itself presents a hurdle, so that doesn’t bode well for the organization of our profession in further details.

For example, herbalism is a key component of TCM, yet the national accreditation board (NCCAOM) does not require the passing of an herbal board exam. California is the only state that requires comprehensive herbal knowledge in order to be a licensed acupuncturist- all other states use the national accreditation standard, if that. In my opinion, this is frightening and leaves our medicine open to justified criticism regarding safety and competence.

Personally, I would love to see the institution of a Traditional East Asian Medicine first doctorate, with stringent herbal prescription standards and a more demanding clinical experience (higher hours and patient count). If this were to be instituted, the profession could launch a real publicity campaign with the infrastructure to support inquiry into the standards of the profession, and we would have a greater ability as a whole to collaborate with integrative medicine teams due to a higher confidence level in our expertise as a profession. Currently, it seems that acupuncturists rely on the popular culture conception of our profession for a sense of legitimacy and acceptance, and we neglect the pursuit of developing a more demanding and standardized base curriculum in our colleges.

All of these thoughts have become incessant over the past week as I have struggled to place myself in a medical hierarchy in a foreign country, when I realize that I am not totally sure of my place in the medical food chain in my own country.

If you have any comments about this line of thought, I would be very interested to hear them- both from acupuncturists and non-acupuncturists! I know that this should be a different post as well, but I just had to add it here… ok I’m getting off my soap box 🙂

Thank you for listening! Stay tuned for much much more!!!

serious blogging face! or is that 'recently-escaped-heat-stroke' face?