CYPA
Health Column September 2018

What is Cupping? A Brief Introduction
by DPT黃冠維

Jack and Sam had just finished playing basketball and were on their way back to the classroom when Sam said, "You played really well today, Jack." Jack pulled off his shirt and showed Sam the black cupping circles all over his back, saying, "These are like my radioactive spider bites. They're where all my powers come from." Sam rolled his eyes and said, "Dude, I know what cupping looks like." Today, we're going to be talking about cupping, including why it’s no longer just a form of traditional medicine, and why more and more athletes are trying it.

Principles of Cupping
Cupping is a technique in which the pressure within a cup is lowered, allowing the cup to seal itself onto meridians, acupoints, or locations of discomfort on the body, causing the area to fill with blood, to bruise, or to blister. Cups come in all sizes, with small cups the size of shot glasses and large cups bigger than your fist. Through the use of burning or suction methods, the lowered pressure within the cup can cause it to adsorb to the surface of the skin. This causes skin and flesh to be sucked into the cup, and the resultant force causes the capillaries in that area to fill with blood or burst. These are the dark circles you see on the skin after cupping.

Uses of Cupping
1. Improve circulation and boost metabolism:  The suction of the cup on your skin causes blood pooling, bruising, and blood vessel expansion, which lead to improved circulation. Cupping may also cause sweating, which when combined with improved circulation can boost your metabolism. 
2. Strengthen immunity: Hemolysis caused by burst capillaries strengthens the immune system’s phagocytic capabilities.
3. Soothe local discomfort: For example, if inflammation or compression in your upper back is causing oxygen deficiency, adhesion, or spasms, you can use cupping to improve local circulation and soothe discomfort. 
4. Relieve pain: Negative pressure inside the cups pulls on the skin, superficial muscles, and fascia. When combined with improved circulation, this can relieve some soft tissue pain and spasms.
All in all, cupping is a safe and effective treatment method that can loosen tight muscles and fascia and improve local circulation through the use of physical relaxation methods. This is helpful for soothing tight or sore muscles and increasing range of motion of muscles and joints. Cupping is suitable for treating muscle tightness caused by fatigue and high-intensity workouts, which is why many NBA players and other athletes like cupping. 

Cupping Recommendations
It is recommended that each cup be placed on the skin for 5-10 minutes; longer times may cause bruises, blisters, ulceration, or tissue death. It is also not recommended to use cupping too frequently, but there is currently no general consensus on what constitutes "too frequently." Most doctors make a decision based on each patient's physical condition, so ask your traditional Chinese medicine physician, therapist, or massage therapist. Cups should be placed on well-muscled areas with no hair, such as the shoulders, waist, back, or stomach. You should be in a comfortable position during cupping, and commonly used positions include sitting, lying on the back, lying on the side, or lying face down. Cupping should be performed gently and should avoid areas where dense blood vessels and lymph nodes are located, such as the heart, underarms, and groin. 

Contraindications for Cupping
Cupping cannot be performed if you have any of the following conditions:
1. Heart disease 
2. Hemophilia 
3. Anasarca symptoms 
4. Full-body skin disease or local damage, such as skin allergies, ulcers, or ruptures
5. Extreme weakness, emaciation, or lack of skin elasticity
6. Persistent high fever, convulsions, or spasms

Skin Color After Cupping
From the perspective of traditional Chinese medicine, different skin colors after cupping represent various states of health or possible illnesses lurking. 
1. Purple-black: Insufficient blood supply or a buildup of cold-evil.
2. Purple with black spots: Qi and blood stagnation. 
3. Purple spots with lumps of different depths: Rheumatism
4. Bright red and partially warm: yang syndrome, heat, excess syndrome, exuberant heat toxin, yin-vacuity, effulgent fire. 
5. Red and dark:blood lipid viscosity, hyperlipidemia, insufficient blood supply. 
6. With pale spotted bruises or blood blisters:vacuity cold, dampness evil/damp-pathogen. 
7. Slight itching:Wind-pathogen/wind evil, dampness.
8. Blistering, swelling, with moisturous cup: Cold symptoms, dampness accumulation.
9. With water drops in the cup:Severe cold-damp
10. Red-purple, dark red:Yin symptoms, cold symptoms, blood stasis
 
 
Retrieved from: 好痛痛 - 復健科、骨科、物理治療醫療資訊  https://blog.easepain.tw/huang-kuan-wei/cupping-therapy/ 

 



Use of Acupuncture in Sports Medicine: Pain Relief, Relaxation, and Adhesion Treatment II
By Dr. 王凱平

Case Study: Shoulder Injuries in Baseball
If acupuncture is performed correctly, it can be a great method for muscle and soft tissue treatment. For example, the shoulder is a common area of pain and injury for pitchers, and pitchers often experience tightness, soreness, weakness, and tendonitis in their biceps.

Another easily injured muscle is the supraspinatus, a rotator cuff muscle that is responsible for stabilizing the shoulder. Repeated injuries over long periods of time may cause chronic tendonitis, which may lead to adhesion, scarring, and tendon calcification. These can all cause pain, limited range of motion, and influence movements. Whether it’s bicep tightness or supraspinatus tendonitis, acupuncture can be used to relax specific muscles and relieve pain. Where there is already adhesion and scarring, acupuncture can also be used as a treatment. Of course, more complicated shoulder issues can’t be solved with a single type of treatment, but rather must be accompanied by a complete treatment and training regimen. For example, physical therapists can perform muscle relaxation and improve joint range of motion, platelet-rich plasma (PRP) prolotherapy can stimulate local tissue repair, Flexi-Bar exercises can help facilitate control of specific muscle groups, and trainers and coaches can help improve core stability and adjust pitching motions to decrease risk of injury.  

Acupuncture Risks and Precautions 
Are there any situations where acupuncture is not appropriate? Generally, the most common side effects of acupuncture are dizziness and fainting. Similar to motion sickness, those who experience these symptoms during acupuncture often have preexisting health conditions; only a small portion is caused by overstimulation during acupuncture. Usually resting for a period of time will clear up any side effects. In more dangerous situations, sudden fainting may lead to head injuries. Acupuncture is not recommended for those that are overtired, weak, hungry, or otherwise in poor health. During treatment, patients should communicate regularly with their doctor regarding sensations in order to prevent overstimulation, and doctors should immediately be notified at the first instance of dizziness. Having someone accompany you during treatment is best, as they can help to support you if you feel dizzy.

Please remember that acupuncture is not a cure-all, and sometimes other treatment methods are needed. For example, torn ligaments require stabilization and repair treatment, and at most, acupuncture can provide local pain relief during the acute stage. Acupuncture is also not as effective for fractures, serious nerve compression, or nerve injuries. 

Modern Issues in Chinese Medicine 
As a sports medicine doctor licensed in both Chinese and Western medicine, I feel that there are many areas where traditional Chinese medicine treatments can be used in sports medicine. For example, bone traumatology can provide immediate relief for the arms, legs, head, neck, and spine, as well as for dislocations. Chinese internal medicine and traditional Chinese medicine are areas that will provide opportunities for future interdisciplinary collaboration, but the lack of information regarding banned substances in sports is still an issue. 

The main problem is communication
because the logic used in Western and Chinese medicine is very different. Although I often use Western medicine and easily understandable methods to explain Chinese medicine, it doesn’t mean that others can completely explain how it works. Due to its long history and vast scope, Chinese medicine has a unique thought process and operative fabric. This uniqueness is hard to communicate through writing and makes large-scale research difficult. However, these are all problems that can be dealt with in the future.

Whether in sports medicine or other disciplines, Chinese medicine has the potential to be more broadly used. 
Hopefully this article can help others to understand the principles of acupuncture, as well as the prospects and challenges facing traditional Chinese medicine.



Retrieved from: 好痛痛 - 復健科、骨科、物理治療醫療資訊 https://blog.easepain.tw/dr-kp/acupuncture-introducing/ 

 



Use of Acupuncture in Sports Medicine: Pain Relief, Relaxation, and Adhesion Treatment I
By Dr. 王凱平

In my last article regarding sports medicine, I mentioned that I used acupuncture to help a swimmer on the Taiwanese national team to relieve wrist pain issues. This was actually not a singular case. At the Incheon Indoor and Martial Arts Games, I also used acupuncture to help a bowler relieve muscle tightness and temporarily decrease the pain of chronic biceps tendonitis, and the athlete eventually helped the team win the championship. Acupuncture is applied in sports medicine for three main purposes: pain relief, relaxation of muscles, fascia, and other soft tissue, and treatment of tissue adhesion.

Acupuncture for Pain Relief 
Being poked and pricked by a needle should hurt. How does acupuncture relieve pain? Acupuncture is not some ancient Chinese myth or mysterious power, there is actually scientific evidence to prove its effects. Scientific evidence supporting acupuncture for pain relief includes Gate Control Theory and Endorphin Theory.
Acupuncture X Gate Control Theory
Gate Control Theory was first proposed in the 1960s; simply put, if nerves are provided with a stimulus, once the nerve channel has become completely occupied by these stimuli, it is impossible for pain sensations to pass through these channels to the brain. How does acupuncture create stimuli that obstruct pain? Through the feelings of “soreness, numbness, swelling, and heaviness,” which traditionally are referred to as “obtaining qi.” Apart from acupuncture, other techniques that utilize Gate Control Theory pain relief include electrotherapy, tap massage, and more.
Acupuncture X Endorphin Theory
Endorphin Theory, which developed slightly later than Gate Control Theory, arose in the 1970s when researchers discovered that upon giving the brain stimuli, it released endorphin that relieved pain; acupuncture is one such stimulus. In the 1980s, it was discovered that acupuncture along with electric stimuli of different frequencies could cause the release of different endorphins and different effects. Thus, many later Chinese medicine doctors added electrotherapy to their acupuncture, a process called “electroacupuncture.”

 

Photo from: http://www.afdw.af.mil/News/Photos/?igtag=779th%20medical%20group

Other Acupuncture Pain Research 
In addition to the two above theories, other late-20th-century acupuncture and pain relief researches include “pain receptors of nerve endings”, “the effect of glial cells on pain transmission”, and “the influence of Adenosine A1 receptors on local pain control.” Today, there is plenty of evidence to prove that acupuncture influences the ability of nerve endings to feel pain from the central nervous system, and it could even affect the expression of related genes. 
 
Acupuncture for Muscle and Soft Tissue Relaxation
Long-term muscle tightness can cause many problems, including affecting joint movement, as well as causing trigger points, soreness, and poor postures. Although less often discussed, long-term muscle tightness can also cause excessive tension on tendons, which can lead to tendonitis. Common muscle relaxation methods include hot packs, soft tissue mobilization & massage in physical therapy, stretching, 
kinesiotape, and massage guns. Acupuncture can also relax muscles and relieve tension on tendons. Although current evidence is not complete, the aforementioned effects usually show in the treatments. Acupuncture causes muscle contraction and twitching sensations, as well as the “obtaining qi”  mentioned above. These reactions can relax tight muscles and relieve pains of muscle and tendon. According to Chinese medicine, muscle twitching, soreness, numbness, and pain are all reactions to “obtaining qi”, while in modern Western medicine it is referred to as “Local Twitch Response”.  

Acupuncture for Adhesion 
After an injury, tissue will recover and heal, but in the process, it may grow uncontrollably; this phenomenon can be seen most clearly in scarring on the skin. Adhesion occurs when uncontrolled growth causes tissue that could originally move freely to stick together. Muscle adhesion may affect contraction and relaxation of muscles, tendon adhesion may cause chronic tendonitis, and fascial adhesion may cause pain and affect movement. Adhesion can also affect local circulation and nerves and obstruct sensations.

The central principle of adhesion treatment is “reconstruction after destruction” because the adhering tissue must first be destroyed to allow it to regrow neatly. There are many ways to accomplish this, such as manual treatment to release adhesion, extracorporeal shockwave therapy (ESWT), stretching, and fluid injections to open up adhesion. Chinese medicine methods include acupuncture (
including acupotomy) and traumatology. Please see the related video here:  https://www.youtube.com/watch?v=xRbyQA-HPoU

How Does Chinese Medicine Use Acupuncture to Treat Adhesion?
First, we find the location of the adhesion, then use needles of different widths to pick apart the adhesion. When
performingacupotomy, the tip of the needle is actually a tiny scalpel that can perform small-scale incisions. Imagine two pieces of cardboard stuck together, then imagine using tiny needles or scalpels to cut them apart. 

(Article to be continued......)

Retrieved from: 好痛痛 - 復健科、骨科、物理治療醫療資訊 https://blog.easepain.tw/dr-kp/acupuncture-introducing/ 

 



Does Dairy Cause Dampness? 
Examination of a Theory

By Brandon LaGreca, CAc, MAcOM

The topic of dairy consumption was brought up at a scalp acupuncture seminar I recently attended. The Western presenter, educated and practicing in China, made the blanket statement that humans are not meant to consume dairy and that doing so causes dampness and phlegm accumulation, one of the key pathogenic factors underlying neurological disorders treated with scalp acupuncture. I questioned the presenter about this assumption, but she held firm to her conviction, citing the observation that no other mammalian species consumes milk after weaning. This is one of many arguments against dairy consumption, but the claim that dairy causes pathogenic dampness within the theoretical tenets of traditional Chinese medicine is our chief concern. In this article, I will scrutinize several concerns with dairy consumption and challenge the assumption that dairy categorically deranges metabolism in a manner conducive to damp/phlegm accumulation. So we are all on the same page, the TCM damp/phlegm signs and symptoms typically attributed to dairy consumption are the same as we would equate with Spleen qi deficiency. These include bloating, loose stools, and thick tongue coating, as well as Lung phlegm accumulation evidenced by sinus congestion and drainage or coughing of clear phlegm.

The Evolution of Dairy Consumption
First, let's place human dairy consumption within an ancestral framework. Humans are born with a sufficient amount of the enzyme lactase to break down breast milk as a baby's first and only food for the first few months of life. After weaning, some humans display lactase persistence, a genetic trait that enables the efficient breakdown of the milk sugar lactose into adulthood. This phenotypical shift worked its way into the human genome following the domestication of ruminant mammals that were herded and milked by pastoral communities. Dairy provided a novel source of nutrition and calories, bestowing an evolutionary advantage for those expressing the gene mutation for lactase to be secreted in the brush border of the small intestine. Lactase persistence has existed in the human genome for thousands of years, with the genotype as high as 80 percent in those of European descent. Thus the basic premise that all humans are not fit to consume dairy is patently false given the epigenetic changes that have occurred over millennia, and this doesn't even take into account the shift in the human intestinal microbiome toward Lactobacillus species that break down lactose. Humans are nothing if not adaptable. That said, I will pose the broader question of whether dairy can be made easier to digest for those who do not exhibit lactase persistence. Here, human ingenuity in the face of survival pressure has led to the development of the culinary strategy of fermenting milk to aid digestion and assimilation while simultaneously inhibiting spoilage, providing a food source during the lean winter months. Nutritional science describes two basic components of milk that can be difficult to digest in some individuals and highly allergenic in others. The first is the milk sugar lactose that is broken down by the enzyme lactase. The other is the protein casein that is metabolized by a number of proteolytic enzymes. I believe lactose to be the dominant damp factor, as we think of it in traditional Chinese medicine, with casein being less problematic but significant for some individuals.

The
lacto
-fermentation process for making yogurt or kefir introduces a bacterial culture that consumes the milk sugar lactose as its fuel source. In turn, the finished product is both low in lactose (or virtually free of lactose, depending on the length of fermentation) and full of probiotics. When cheese is made, the curds (fat and carbohydrate component) are separated from the whey (protein component), compressing those curds and allowing them to safely ferment, sometimes over the course of several months, producing a cheese that is much lower in lactose. Butter is made by churning skimmed cream from whole, non-homogenized milk, a process that lowers lactose; ghee is clarified butter, produced by heat separating out the remaining casein until only pure butterfat remains. In all of these instances, diverse traditional cultures have found ways to store and consume dairy foods without the benefit of lactase persistence. True, modern Chinese cuisine does not favor heavy cream sauces or artisan cheeses, but anthropological evidence suggests that Asians have long availed themselves of dairy foods. The earliest evidence of cheese was found in the tombs of 3,800-year-old mummies in China's Taklamakan Desert. Given this evidence, it is shortsighted to accept the notion that just because our species is unique in consuming dairy after weaning, we are not meant to do so. Humans do a lot of unique and curious things. What is relevant is the ancestral record that shows a long history of dairy consumption in various forms. This insight was not lost on the founders of Chinese medicine, who carefully detailed the qualities and nature of milk. Its energetics are sweet in flavor; neutral in nature; and enter the Heart, Lung, and Stomach channels. According to Paul Pitchford in "Healing with Whole Foods," "… milk builds qi vitality, the blood, and the yin, which includes the fluids and tissue of the body."

Toxic Milk
From there, things start to get a little dicey, with the Industrial Revolution not doing milk any favors dairy cows were taken off pasture, kept in close quarters, and fed a suboptimal diet (often leftover grain mash from alcohol distillation, milk became a serious vector for communicable diseases. The cows became sick, as did the humans who drank their milk. At this juncture in history, pasteurization was one of two strategies championed to reduce the risk of foodborne illness. Alternatively, certified raw milk from cows kept on pasture was chilled immediately after the cows were milked then transported into burgeoning urban areas. This became the purview of the now nearly extinct milkman. Pasteurization was chosen as the most commercially viable solution, one that gave rise to a whole new industry of milk processing. Although the industry line is that pasteurized milk is exceedingly safe and raw milk is inherently dangerous, the former can and has become contaminated post-pasteurization, resulting in numerous illnesses. On the other hand, the claim that drinking raw milk is akin to playing Russian roulette is a laughable assertion given the long ancestral history of raw dairy consumption. The key to safe raw milk consumption is obtaining milk from a dairy that specifically produces milk for raw consumption rather than from a high-volume factory farm where the milk is intended for pasteurization. An excellent resource to recommend to patients interested in accessing authentic and healthy raw milk is
www.realmilk.com. Raw milk has seen a resurgence in popularity following the observation that pasteurized milk is more difficult to digest and can more readily produce signs and symptoms of damp/phlegm accumulation. This is in part due to the enzymes inherent in raw milk becoming destroyed during the pasteurization process. These enzymes, chief among them being lactase, are naturally produced by bacteria the milk assumes from the microbiological terrain of the cow as it is milked. Raw milk is pre-digested to maximize nutrient absorption by growing mammals.

The Dampness Factor
Clearly, this is not a black or white issue; a nuanced approach to healthy dairy consumption would take all these factors into consideration. If recommending an elimination diet to detect suspected food sensitivities, be mindful of a patient's constitution and observe the development of damp signs with the reintroduction of dairy. Those with a tendency toward Spleen deficiency are particularly susceptible. When reintroducing dairy, quality matters. Raw milk from heritage breeds grazing on organic pasture is less damp than pasteurized and homogenized milk from a commercial dairy plant. Milk proteins vary depending on the species of ruminant animal. Alpha-lactalbumin and beta-lactoglobulin are the two main proteins found in cow's milk. The latter protein is thought to contribute to milk allergies due to a mutation in cows that causes them to produce beta-lactoglobulin in which a proline molecule is replaced by a histidine molecule. High-volume producers such as Holsteins are of a genetic variant known as A1 that express this amino acid difference. Breeds such as Jerseys and Guernseys, by contrast, are of the older A2 variant that retains proline. The amount consumed matters. Having one glass of milk or a few slices of cheese every day may contribute a negligible amount of dampness while providing an easily assimilable form of calcium and other nutrients. Processing matters too. Homemade yogurt and kefir have varying degrees of lactose and casein. If we consider one or both of these carbohydrate and protein fractions to be damp producing upon interaction with the human intestinal terrain, fermenting or processing milk into one of these probiotic-rich superfoods would render it more suitable for the Spleen-deficient constitution. Ghee is pure butterfat and is tolerated by virtually everyone. When derived from the milk of cows on pasture during the warmer weather and abundant pasture growth of the spring flush, ghee has a rich yellow color indicating the presence of vitamin A and is replete with the healthy fat conjugated linoleic acid (CLA). Dairy foods offer many benefits and have accented many cuisines the world over. Finding a tolerable form and quality of dairy will expand a patient's diet, maximize nutrition, and in most cases provide some form of probiotics, all without contributing to an appreciable accumulation of dampness or phlegm when considered in context with a patient's overall diet and constitution.
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