Neck pain research: acupuncture and alexander technique better than drugs
Nobel prize for Chinese medicine
Happy New Year - a time for resolutions and change?
Health and happiness seem to go hand in hand and new year’s resolutions imply that a quick fix can cement this state. However it can be futile trying to attain this fragile balance as we are often unsettled by the changing tide of life.
Happiness is about appreciating life now and finding ways to achieve subtle transformation. I find two things useful to consider:
What am I grateful for?
What am I looking forward to?
In Chinese medicine there were two major breakthroughs at the end of 2015. Firstly a major study proving the efficacy of acupuncture in treating neck pain. Secondly, a nobel prize symbolising the West's acknowledgement and appreciation of the Chinese woman who discovered a cure for malaria with Chinese herbal medicine.
I am excited about working on a new wellbeing program at Breathe-Waterloo (which I will reveal in the next newsletter). For now, a look at yin yang theory and how change is achieved through Chinese medicine.
Yin yang is a well-known symbol but how does it relate to Chinese medicine?
Chinese medicine is based on a dialectical logic ‘which assumes that a part can only be understood in relation to the whole’1. The daoist thought that explains relationships, patterns and change is called yin yang theory.
Yin yang theory is a philosophical construct of two polar complements. It is represented by well-known symbol of the circle divided into the black and white ‘fish’ with the black dot or eye in the white and the white eye in the black fish. The traditional Chinese character yin (陰) derives from the image of of the shady/dark side of the hill and yang (陽) the sunny/light side.
The two are complementary opposites (black/white, night/day, passiveness/activity, water/fire) yet mutually interdependent. The importance of this interplay can be seen in nature as without night there would not be day which then turns into night again. ‘Yin and Yang are not only a set of correspondences; they also represent a way of thinking. In this system of thought, all things are seen as parts of a whole… There are no absolutes. Yin and Yang must, necessarily, contain within themselves the possibility of opposition and change.’
For this reason, Chinese medicine treats the body as a whole and part of nature/the universe. Yin yang has become the overarching of the 8 principles of diagnosis in traditional Chinese medicine (TCM) which also include hot and cold, shi (full/ excess) and xu (empty/deficient), internal and external. However like the eye of the fish, within each pattern is a small trace of the opposite waiting for transformation. Thus the role of the Chinese doctor is to choose the armoury in his or her toolkit (acupuncture needles, moxibustion, cupping, tuina massage, Chinese herbs, lifestyle advice – diet, exercise, work/family) to help promote change and restore balance in the patient.
Qigong & taijiquan courses starts 13 January Laura will be teaching the Yin Yang Qigong set learnt from Grandmaster Chen Xiaowang (left) this term at Morley college
Acupuncture sessions and Alexander technique lessons both result in greater long-term pain reduction than standard treatment alone
A randomised-control trial (1) conducted at York University and published in the Annals of Internal Medicine (Nov 2015) enhances the scientific legitimacy for two therapies. Acupuncture, the ancient practice of needle insertion, and the Alexander Technique, a program that teaches people how to avoid unnecessary muscle tension throughout the day and improve posture, coordination, balance and stress, are two complementary therapies often used to help treat neck pain.
The study included 517 people with neck pain that had lasted at least three months, and an average of six years. Their neck pain was rated based on questionnaires at the outset, three months in, six months in, and 12 months after the study began.
‘Treatment was completed at around four to five months after entering the trial,’ explains Hugh McPherson, lead researcher. ‘Then at 12 months, well after the end of treatment, we found sustained reductions in pain of around 30 percent on average for both those receiving acupuncture or Alexander Technique lessons.’ Both methods help patients increase their ‘self-efficacy,’ that is, their ability to reduce their pain levels using self-care methods that do not involve medication, he adds. 1. Annals of Internal Medicine, online November 2, 2015.
The participants were randomly assigned to 12 x 50-minute acupuncture sessions, 20 x 30-minute one-on-one Alexander Technique lessons, or usual care, which included prescription pain medication, doctors visits and physical therapy. The acupuncture or Alexander sessions were offered within the first five months of the study, and participants had the option of paying privately for additional sessions thereafter. On average, acupuncture participants attended 10 of their 12 sessions and Alexander participants attended 14 of their 20 sessions.
Based on the symptom questionnaires, pain had reduced by more than 30 percent from the beginning of the study to the 12 months point for those in both treatment groups, the authors reported in the Annals of Internal Medicine.
There no serious adverse events related to either intervention, according to the authors.
A landmark review in 2012 involving almost 18,000 people with chronic pain concluded that acupuncture was better than standard care and sham acupuncture (which proved the effect is not due to placebo of simply sticking needles in the body.) ‘You get a two-fold effect with acupuncture for pain: a natural pain-relieving effect and an anti-inflammatory effect,’ says Jamie Starkey, lead acupuncturist at Cleveland Clinic’s Center for Integrative Medicine, who was not involved in the new study. Acupuncture manipulates the nervous system, she says, activating the release of pain-relieving endorphins. ‘With neck pain patients, a lot will get steroid injections or take a non-steroidal anti inflammatory, like ibuprofen or a prescription medication,’ says Starkey. ‘Those medications or injections have an anti-inflammatory effect on the body, but the acupuncture needles can do that naturally.’ The influx of new research has helped legitimize alternative therapies like acupuncture, says Starkey. ‘That’s really brought acupuncture to the forefront of people’s minds and attention, and physicians are a lot more willing to refer their patients to an acupuncturist.’
Nobel Prize for Chinese woman who discovered cure for Malaria
Tu Youyou has become the first Chinese woman to win a Nobel Prize, for her work in helping to create an anti-malaria medicine. The 84-year-old's route to the honour has been anything but traditional.
She won the Nobel Prize for medicine, but she doesn't have a medical degree or a PhD. Tu Youyou attended a pharmacology school in Beijing. Shortly after, she became a researcher at the Academy of Chinese Traditional Medicine.
In China, she is being called the ‘three noes’ winner: no medical degree, no doctorate, and she’s never worked overseas.
She started her malaria research after she was recruited to a top-secret government unit known as ‘Mission 523’. In 1967, Communist leader Mao Zedong decided there was an urgent national need to find a cure for malaria. At the time, malaria spread by mosquitoes was decimating Chinese soldiers fighting Americans in the jungles of northern Vietnam. A secret research unit was formed to find a cure for the illness.
The antifebrile effect of the Chinese herb Artemisia annua (qinghaosu 青蒿素), or sweet wormwood, was known 1,700 years ago. Tu was the first to extract the biologically active component of the herb – called Artemisinin – and clarify how it worked. The result was a paradigm shift in the medical field that allowed for Artemisinin to be both clinically studied and produced on a large scale.
Tu has always maintained that she drew her inspiration from the medical text of a fourth-century Chinese physician and alchemist named Ge Hong 葛洪 (circa 283-343).
His Emergency Formulas To Keep at Hand (Zhouhou beijifang 肘後備急方) can best be understood as a practical handbook of drug formulas for emergencies. It was a book light enough to keep “behind the elbow” (zhouhou), namely, in one’s sleeve, where Chinese men sometimes carried their belongings. We can discern from Ge’s astute description of his patients' symptoms that people then suffered not only from malaria but also from other deadly diseases including smallpox, typhoid and dysentery.
Beyond recording the fever-fighting qualities of Artemisia annua, Physician Ge also wrote about how Ephedra sinica (mahuang 麻黃) effectively treated respiratory problems and how arsenic sulphide (“red Realgar,” xionghuang 雄黃) helped control some dermatological problems.
Traditional ingredients, modern drugs
Just because a compound has natural roots and has long been used in traditional medicine is no reason to take it lightly.
Ironically, in 2004, the FDA actually banned ephedra-containing dietary and performance-enhancing supplements. They’d been the cause not only of serious side effects but also several deaths. The ban remains in effect in the US despite a court challenge from ephedra manufacturers. Related drug ephedrine, however, is used to treat low blood pressure and is a common ingredient in over-the-counter asthma medicines.
As for Realgar, its toxicity was well-known in both ancient Greece and Chinese antiquity. In Chinese medical thought, though, skillfully administered toxins may also be powerful antidotes for other toxins. Realgar thus continues to be used in Chinese medicine as a drug that relieves toxicity and kills parasites. Applied topically, it treats scabies, ringworm and rashes on the skin’s surface; taken internally, it expels intestinal parasites, particularly roundworms.
It was validation of this traditional drug as an antimalarial in the 1940s, in fact, that set the foundation for Chinese leader Mao Tse Tung’s directive two decades later in the late 1960s to find a cure for malaria. Indeed, Tu’s research is best understood within the complex politics and history of top-down support from the Chinese government of Chinese medicine in mainland China during the long durée of the 20th century, and not just in the Maoist period.
Even outside mainland China, though, such research has yielded results. In the 1970s, for example, US and Japanese researchers developed the statin drugs used to lower cholesterol from studying the mold Monascus purpureus that makes red yeast rice, well, “red.”
Empirical evidence of the medical efficacy in the rich Chinese medical archive from centuries earlier similarly influenced the initial direction of this research.
So is this Nobel Prize for Tu’s discovery a signal that Western science has changed how it perceives alternative systems of medicine? Perhaps, but only slightly.
One of the Karolinska Institute panelists acknowledged that there are many sources from which scientists draw inspiration to develop drugs. Among them, we should not ignore the long history of experiences from the past. As he clarified, such sources may be inspirational, but the old herbs found there cannot be used just as they are. Don’t underestimate the sophisticated methods Tu used to extract the active Artemisinin compound from Artemesia annua, another one of the panelists concluded.
So the Nobel Prize is not only acknowledging this complete transformation of a Chinese herb through modern biomedical science into something powerfully efficacious, but also the millions of lives saved because of its successful application worldwide, particularly in the developing world.