Welcome to my blog

Acupuncture specialist for Fertility, Facial rejuvenation, Pain relief, Fatigue.
Based at Harley Street and Kensington Central London.Qualified as a medical doctor in Western medicine in China with a Medical degree from Beijing, China and a PhD degree from the UK. Over 25 year research and clinical experiences

Doctor who is passionate about acupuncture

I love what I do, I am good at it and I am always there for my patients. If you come and see me, you will know why I am standing out.
This blog is to introduce latest development and research of acupuncture and offer a chance of awareness of more treatment options for your condition. The blog is for information purpose only.

About Me

My photo

My specialised areas include fertility, facial rejuvenation, acne, vulvodynia, various pain conditions, chronic fatigue, neurological conditions, digestive problems

Practice contact for appointments and addresses 

Kensington: for appointments at Anamaya center Kensington (Mondays, Tuesdays, Thursdays, Fridays, Saturdays) please call at 02030110355 or email at info@anamaya.co.uk
Address: 1 Adam and Eve Mews, Kensington, London W8 6UG
2 min walk from High Street Kensington underground station

Harley Street: for appointments  at Harley Street (Wednesdays) please call ALO clinic at 02076368845 or email at info@aloclinic.com
Address
Suite 3 Harmont House
20 Harley Street, London W1G 9PH
5 min walk from Oxford Circus underground station

My background: I became a qualified medical doctor 25 years ago in Western medicine  in China and was well trained in Western medicine together with Chinese medicine in the best Medical University in Beijing, China. Particularly I was trained with Ji-sheng Han famous professor and neuroscientist in China and with Dr Zheren Xuan--famous orthopedics expert and founder of soft tissue surgery in China. Furthermore I had training in dermatology and oral and maxilofacial surgery in China. Also I had training in fertility and had research experiences in uterine smooth muscles and blood vessels in China and the UK. I am dedicated to treat patients with acupuncture and am recognised as one of the world leading acupuncture specialists.

I obtained a PhD degree in the University of Leeds in the UK.
I had post doctoral training and worked as a senior researcher in St George's hospital, London, UK.
I had frequently presented my research findings in the top international conferences in the field.
I have many publications including ebooks and articles.

I have many year clinical experiences. Over the years of practising, I have developed unique treatment approaches for infertility, skin aging, acne, vulvodynia, bladder pain, neck pain, headache, migraine, shoulder pain, back pain, fatigue, hot flushes, nerve pain, chronic prostatitis, insomnia, Parkison's disease, MS, acid reflex, IBS etc to achieve best treatment results. 

My devotion and skills are highly praised by my patients. 

My eBooks

Facial acupuncture Facial rejuvenation Acne treatment
Know your ovary to get pregnant
Know fertility and acupuncture to get pregnant
Vulvodynia, is vulval pain in your mind
Energy fatigue and acupuncture
Headaches, Neck pain and shoulder pain

Monday, 23 April 2018

Hip bone and the muscles attached

The hip bone or pelvic bone is a large flat bone connected with sacrum and coccyx of the lower spine. Two hip bones join each other at front midline and join together with sacrum and coccyx at the low back forming pelvis surrounding the pelvic cavity which accommodates bladder, reproductive system and bowels.

The hip bone is formed by three parts: illium, ischium and pubis.

The ilium is the highest and largest part of the hipbone consists of the body and wing.

The ischium is the lowest part of the hip bone and made up of three parts–the body, the superior ramus and the inferior ramus.

The pubis is at the anterior of the hip bone. It is divided into the body, superior ramus and inferior ramus.

The hip bone has a few groups of muscles attached as follows

The abdominal muscles include the abdominal external oblique muscle (attaches to the iliac crest) , the abdominal internal oblique muscle (ataches to the pectin pubis) and the transverses abdominis muscle (ataches to the pubic crest and the pectin pubis),

The back muscles include the multifidus muscle (attaches to the medial surface of the posterior superior iliac spine, the posterior sacroiliac ligaments and part of the sacrum)

The gluteal muscles include three gluteal muscles: gluteal maxmus muscle, gluteal medium muscle and gluteal mininus muscle. They all arise from the outer surface of the hip bone and

The lateral rotator group of muscles include piriformis muscle, superior gemellos muscle, obturator internus muscle , inferior gemellos muscle and obturator externus muscle.

Adductor group of muscles include adductor brevis, adductor longus, adductor magnus, adductor minimus, pectineus, gracilis and obturator externus.

Hamstrings include long head biceps femoris, semitendinous and semimembranosus

Two muscles at the anterior of the thigh rectus femoris muscle and sarturius muscle

One shoulder muscle--- the latissimus dorsi muscle (attaches to the iliac crest ).

Thursday, 19 April 2018

Suffer from hay fever? Acupuncture can help

Hay fever known as allergic rhinitis is a condition caused by inflammation in the nose whichoccurs when the immune system overreracts to the allergens such as pollen, pet hair, dust, or mold. In spring time, people with seasonal hay fever would surfer when others enjoy the spring. It is because the immune system overreacts pollen in the air and causes inflammation in the nose.

Acupuncture is effective to treat hay fever. There is a paper just published titled Impact of acupuncture on antihistamine use in patients suffering seasonal allergic rhinitis: secondary analysis of results from a randomised controlled trial. In this research patients were allocated into three study groups: acupuncture plus medication, sham acupuncture plus medication, and medication alone. The data from 414 patients were analysed. The acupuncture group used antihistamines significantly less often compared with the other groups. The pre-post comparison suggested that the acupuncture patients did not need to increase the days of antihistamine use to alleviate their symptoms. Acupuncture appeared to significantly reduce the number of days of antihistamine use for the patients with hay fever.

References
Adam D et al Acupunct med 2018 Feb 10. pii: acupmed-2017-011382. doi: 10.1136/acupmed-2017-011382. [Epub ahead of print]

Friday, 13 April 2018

Suffer from interstitial cystitis? Acupuncture can help

The urinary system, also known as the renal system or urinary tract comprises kidneys (two), ureters (two), bladder and urethra. Urine is formed in the kidneys and then passed through the ureters to the bladder where it is stored. When the bladder is not full of urine, the bladder is relaxed. When the bladder is getting full, it will let the brain know the need to pass urine. If the bladder is working normally, one can put off urination for some time. If there is something that goes wrong with the bladder, urination change is a sign of it.

Interstitial cystitis (IC)/bladder pain syndrome (BPS) is a chronic bladder condition. It is a feeling of pain and pressure in the bladder area and the symptoms have lasted for more than 6 weeks, without having an infection or other clear causes. Symptoms range from mild to severe. For some patients the symptoms may come and go, and for others they don't go away. The pain may be worse when the bladder is full and may be temporarily relieved after urination. The pain could be worse during periods or after having certain foods or drinks. IC/BPS is not an infection, but it may feel like a bladder infection. Women with IC/BPS may feel pain when having sex. This condition is poorly understood. Apart from the pain, it is also accompanied with problems of urination, such as sudden, strong urges to urinate, more frequent urination than normal, pain when passing water, waking up quite a few times during the night to urinate. The exact cause of interstitial cystitis isn't clear. Unlike other types of cystitis, there's no obvious infection in the bladder and antibiotics don't help.

I help people with interstitial cystitis with acupuncture. A patient told me that it is a nice feeling of standing on the beach without having to go to toilet.

Thursday, 12 April 2018

Suffer from shoulder pain? Acupuncture can help

Shoulder pain is very common: about 3 in 10 adults are affected by them at any one time. Frozen shoulder and rotator cuff disorders are most common in middle-aged and older people.

Frozen shoulder

Frozen shoulder is a painful condition in the shoulder. The medical term for frozen shoulder is adhesive capsulitis. It presents a painful persistent stiffness of the shoulder joint that it is difficult to carry out everyday tasks such as dressing, driving and sleeping comfortably. Some people are unable to move their shoulder at all. This is caused when the capsule surrounds the shoulder joint becomes inflamed. The capsule that surrounds your shoulder joint becomes swollen, thickened and tightened This leaves less space for your upper arm bone in the shoulder joint, and makes the movement stiff and painful. The symptoms of frozen shoulder can vary greatly, but tend to get worse slowly over the time. They are usually felt in three stages spread over a number of months or years. This is a common condition affecting about 2% of adults.

The most common symptoms are pain and stiffness in the shoulder. Also the amount of movement in affected shoulder joint is reduced. In severe cases, the shoulder may not be moved at all. Though it is a common condition, the treatment remains challenging. Jain and Sharma from University of Kansas Medical Center USA reviewed current best evidence for the use of physical therapy intervention for frozen shoulder. Therapeutic exercises and mobilization are strongly recommended for reducing pain, improving range of motion and function in patients with stage 2 and 3 of frozen shoulder. Low level laser therapy is strongly suggested for pain relief and moderately suggested for improving function but not recommended for improving range of motion. Corticosteroid injections can be used for stage 1 frozen shoulder. Acupuncture is an option of treatment. Acupuncture with therapeutic exercises is moderately recommended for pain relief, improving range of motion and function.

Many case reports were published showing effectiveness of acupuncture in reducing pain on frozen shoulder. For example, Wang XH et al observed 60 cases with frozen shoulder. These patients were divided into two groups for acupuncture or acupuncture plus moxibustion treatments. The acupuncture points selected were Jianyu (LI15), Jianliao (TE14) and Jianzhen (SI9). Tender points were also selected in acupuncture-moxibustion group. They found that acupuncture alone or acupuncture plus moxibustion were effective for frozen shoulder. Acupuncture combined with moxibustion may have better cured rate, but the effective rate has no significant difference. Some clinical trials suggest that acupuncture may improve recovery in patients with a frozen shoulder, either when used alone or in combination with physiotherapy. Acupuncture has effect of frozen shoulder in reducing pain, inflammation muscle and joint stiffness. This is because acupuncture stimulates nerve ends releasing analgesic substances such as endorphins; it reduces inflammation and improves local blood flow. The meridians involved in treating frozen shoulders are muscle meridian of Hand-Yangming, Hand-Shaoyang, Hand-Taiyang, and three yin meridians of hand appeared at proximal points of shoulder joint.

Rotator cuff disorders

The rotator cuff is a group of tendons and muscles in the shoulder, connecting the upper arm to the shoulder blade. The rotator cuff tendons provide stability to the shoulder; the muscles allow the shoulder to rotate. The rotator cuff keeps the joint in the correct position, allowing it to move in a controlled way. It keeps the upper arm bone in the shoulder socket and it raises and twists the arm. If it is irritated or damaged, rotator cuff disorders occur. Rotator cuff disorders include inflammation of the tendons or a bursa; impingement in which a tendone is squeezed and rubs against bone, calcium buildingup in the tendons, tears of the tendons. Rotator cuff disorders are common cause of shoulder pain. Most rotator cuff disorders are caused by a combination of normal wear and tear and overuse. Using the shoulder for many years slowly damages the rotator cuff. As ageing, everyday activities can lead to changes in the rotator cuff, such as thinning and fraying of the tendons and reduced blood supply. Activities in which you use your arms above your head a lot-such as tennis, swimming, or house painting-can lead to rotator cuff problems. Even normal motions made often over a long period can stress or injure the rotator cuff. A simple movement like lifting a suitcase can cause a rotator cuff tear in an older adult or someone whose shoulder is already damaged. Symptoms of a rotator cuff disorder include pain and weakness in the shoulder. Most often, the pain is on the side and front of the upper arm and shoulder. It may hurt or be impossible to do everyday things, such as comb hair, tuck in shirt, or reach for something. You may have pain during the night and trouble sleep. It is important to treat a rotator cuff problem. Without treatment, it may get weaker and lifting up your arm could be a problem. Acupuncture is very effective to treat rotator cuff disorder and helps reducing the inflammation and pain, relaxing rotator cuff muscles and improving blood supply.

New research shows that acupuncture is effective for shoulder pain

Shoulder impingement syndrome which is the common cause of shoulder pain presents pain and weakness in the shoulder especially when you raise your arm. This will limit the movement of the shoulder making daily life difficult. This syndrome involves the rotator cuff tendon which connects the muscles in the shoulder to the top of the arm. You may experience a constant aching in the shoulder and pain at night. It can start suddenly after an injury or it can come on gradually without any obvious causes. The pain tends to be worse when you raise your arm over the head.

Recently a report has shown the effectiveness of acupuncture for shoulder impingement syndrome. In this report the effect of acupuncture in decreasing the intensity of short- and mid-term pain in the injured shoulder was studied. 68 participants with a mean age of 33.4 years were divided into two groups: one group received true acupuncture and the other received acupuncture at sham points. The treatment was carried out over 4 weeks, with the participants receiving a session every week. The result has shown significant difference in pain reduction between two groups both after treatment and 3 months after treatments. No side effects were reported.

Acupuncture is effective for shoulder pain. Shoulder pain is a common reason for patients to visit an acupuncturist. If you have had acupuncture for this, do you know the effect of acupuncture for shoulder pain is closely related to the acupuncture points chosen? Wang et al has analysed some clinical trial to study the acupuncture points for shoulder pain and they assessed the effectiveness of Ashi points stimulation on response rate compared with conventional acupuncture. They have found that there was a significantly greater recovery rate in group of Ashi points stimulation. The conclusion was Ashi points stimulation might be superior to conventional acupuncture, drug therapy and no treatment forshoulder pain. Another study compared the effect of trigger point acupuncture (TrP), with that of sham (SH)acupuncture treatments, on pain and shoulder function in patients with chronic shoulder pain. After treatment, pain intensity between pretreatment and 5 weeks after TrP decreased significantly. Shoulder function also increased significantly between pretreatment and 5 weeks after TrP. Compared with SH acupuncture therapy, TrP therapy appears more effective for chronic shoulder pain.

Muscles related to shoulder pain

There are many muscles that surrounded shoulder for shoulder movement.

Trapezius muscle

Trapezius muscle is a broad triangular muscle at neck and upper back, one of the largest superficial muscles at the back. It attaches to the base of the skull and extends down to the neck, the upper back until mid back; laterally it inserts to the shoulder blades. There are three functional regions to the muscle: the Upper, middle, and lower trapezius, and each region has its own function: upper region moves the shoulder blades and support the arms; the middle region retracts the shoulder blades and the lower region rotates and depresses the shoulder blades.

Pain caused from this muscle may be on the top of the shoulder, neck, mid back and/or upper shoulder pain; pain at the back of the shoulder blade which could go down the inside of the arm to the ring and little fingers.

Latissimus dorsi

Latissimus dorsi is the largest flat muscle at the back. This muscle is involved in adducting the arms, extending the shoulders and rotating shoulder joints medially. It also plays a role in extension and lateral flexion of the lumbar spine. The latissimus dorsi originated from the lumbodorsal fascia of the lower back, arising from the inferior thoracic and lumbar vertebrae, sacrum, iliac crest, and the four most inferior ribs, it runs laterally up through the back, inferior part of shoulder blades and insert on the humerus at the upper front of the upper arm. Tight latissimus dorsi and the trigger points on the muscles could be one of the causes of chronic mid back pain, shoulder pain, forearm pain, pain between shoulder blades, shoulder blades and pain in front of shoulder. The characteristic of pain is at lower shoulder blade and mid back and also the pain can go down the backside of the arm or the inner side of the arm and reach the hand and 4th and 5th fingers. Pain can be present at the front of the shoulder and to the side of the body just above the hip.

Rotator cuff

Rotator cuff comprises four muscles which are supraspinatus muscle, the infraspinatus muscle, teres minor muscle, and the subscapularis muscle. They all originate from the scapula and insert into humerus. They connect scapula to the head to humerus , stabilize shoulder joint and contribute to shoulder joint movement including abduction, internal rotation, and external rotation of the shoulder.

Rotator cuff disorder is one of the problems that cause shoulder pain. The main symptoms are pain around the shoulder and reduced shoulder joint movement. Acupuncture can help reduce the pain.

Teres major muscle

Teres major muscle is the muscle that connects shoulder blades to the upper arms. It starts from lower angle of the shoulder blade and ends at the upper arm in the front of the shoulder. The teres major muscle adducts the arm, extends the shoulder and rotates it inwardly. It also helps stabilize the humeral head. The pain caused in the teres major trigger is the back of your shoulder and also this pain can radiate to the front and side of the shoulder and down the backside of the arm. The trigger points for this muscle can be found at the lower angle of shoulder blades. Acupuncture can help release the pain.

How many muscles connect the humerus (upper arm) to the scapula (shoulder blade)?

There are muscles that connect the upper arm to the shoulder blades and help the movement of the shoulder. Do you know how many of them? There are seven muscles that connect the upper arm to the shoulder blades. They are coracobrachialis muscle, four rotator cuff muscles including infraspinatus, subscapularis, supraspinatus and teres minor muscles, teres major muscle and deltoid muscle. Overuse or injury to these muscles can cause shoulder and arm pain. Acupuncture can help release the pain.

Deltoid muscles

The deltoid muscle is the big muscle on the shoulder which forms the rounded contour of the shoulder. It has three parts; the front or anterior, middle and back or posterior. The anterior fibers are involved in flexing the shoulder and internally rotating the arm. The posterior fibers are involved in extending the shoulder and externally rotating the arm. The lateral fibers are involved in shoulder abduction. Deltoid muscle strain is less common than rotator cuff muscles strain.

Pectoralis major and minor muscles and shoulder pain

The perctoralis major muscle is a muscle located at the chest. Underneath the pectoralis major is the pectoralis minor muscle- a small triangular muscle.

The pectoralis muscle originated from inner half of the clavicular bone, sternum as well as the cartilage of the sixth or seventh rib and the aponeurosis of the abdominal muscle. The muscle run laterally and insert into the upper humerus. It adducts the arm and rotates the shoulder inwardly, pull down the shoulder joint and elevated the arm in front of you. The muscle trigger points contribute to the shoulder pain and upper and inner side of the forearm.

Pectoralis minor originates from the third, fourth and fifth ribs and it runs upward and laterally and inserts to the surface of the coracoids process of the scapula. It pulls the shoulder blade downward, forward and inward towards the ribs, stabilizes the shoulder, prevents the shoulder blade from being pushed backwards. The trigger point of themuscle contributes to the pain in front of the shoulder, that could radiate to your chest and all the way down the inner arm.

Biceps and the shoulder, arm and elbow pain

In the upper arm, there is a muscle called biceps brachii or biceps. This muscle is two headed lies on the upper arm between the shoulder and the elbow. The two heads start from the scapular of the shoulder and join together to one muscle on the upper arm (humarus) and attach to the bones radius and ulnar in the front of the elbow. The biceps turn the arm outward, turn the palm upward, flex the elbow and flex the shoulder (bring the shoulder forward and upwards). The biceps can contribute to the pain on the front of the arm, the elbow and the shoulder. Also it contributes to the medial rotation of the shoulder.

Triceps

The triceps brachii muscle or three headed muscle of the arm is the large muscle on the back of the upper limb. The three heads include long head, medial head and lateral head. The long head originates from the top of the scapula (the infraglenoid tubercle of the scapula). The medial head originates from the upper part of the limb (the groove of the radial nerve, the dorsal surface of the humerus, the medial intermuscular septum and the lateral intermuscular septum). The lateral head originates from the back of the upper limb (the dorsal surface of the humerus, lateral and proximal to the groove of the radial nerve, the greater tubercle down to the region of the lateral intermuscular septum. The three heads join together, form a tendon and attach to the elbow (the olecranon process of the ulna). The triceps extend the elbow and shoulder joint to straighten the elbow and move the arm backwards and also pull the arm towards the body. If the triceps contain trigger points, you can experience pain on the shoulder, arm, elbow or the pain can radiate to the forearm.

References
Wang XH Zhongguo Zhen Jiu (2010) 30:364-6
Jain TK and Sharma NK J Back Musculoskelet Rehabil (2013) Nov 27
You Z et al Zhongguo Zhen Jiu (2014) 34:565-8
Wang et al Chin Integr Med (2015) Jun 30
Itoh K et l J Acupunct Meridian Stud (2014) 7:59-64
Rueda Garrido JC et al Complement Ther Med (2016) 25:92-7

Tuesday, 10 April 2018

Suffer from chronic pelvic pain? Acupuncture can help

Pelvis (or pelvic region) is the region between the abdomen and thighs. It includes sacrum and the coccyx at the back, pelvic bone, pelvic cavity, pelvic floor and perineum. Within pelvic cavity there are bladder, reproductive organs, and the rectum. Around the pelvic bone there are skeletal muscles that attach the bone. Pelvic pain is the pain in the pelvic region (lower abdomen). Pelvic pain can be a sign of the problem with one of the organs in the pelvic cavity, such as bladder, lower intestine, rectum and reproductive system (i.e. uterus, ovaries, fallopian tubes etc in women and prostate in men).

The common causes of pelvic pain are appendicitis, bladder disorders, sexually transmitted diseases, kidney infection, kidney stones, intestinal disorders, nerve condition, hernia, pelvic inflammatory diseases, IBS, (ovulation, periods pain, endometriosis, ovary cysts in women), (prostatitis in men) and many more. Diagnosis is needed by doctors.

Chronic pelvic pain which is continuous or episodic pain in the lower abdomen or pelvis lasting at least six months is one of the most common pain conditions experienced by women. It has great negative impact on women’s quality of life including constant physical and psychological aspects. It depends on what causes the pain and various treatments are available including surgical and non surgical approaches such as hormonal therapy. Improving day-to-day pain management, functioning, and quality of life through multidisciplinary and holistic approaches are also recommended care to women with chronic pelvic pain. The use of complementary health approaches is common for pain conditions. An estimated 35-52% of patients with chronic pain use therapies such as vitamins and mineral supplements, massage therapy or acupuncture for their symptoms. This is applied to chronic pelvic pain. A survey showed that 60% of perimenopausal women with self-reported pelvic pain, and 84% of women with interstitial cystitis used some form of complementary medicine. Recently a study from the US has shown that most women who used acupuncture (91%) had at least some improvement in symptoms based on self-report.

Recent review has shown that acupuncture can reduces chronic prostatitis/chronic pelvic pain syndrome for men. In this review, (three studies, 204 participants) based on short-term follow-up, acupuncture reduces prostatitis symptoms in an appreciable number of participants compared with sham procedure Acupuncture likely results in little to no difference in adverse events. It probably also decreases prostatitis symptoms compared with standard medical therapy in an appreciable number of participants

References

Chao et al Pain Med (2015) 16:328-40

Franco JV et al Cochrane Database Syst Rev (2018) Jan 26

Saturday, 7 April 2018

Dry and scaly skin? Acupuncture can help

70% of our body weight is made up from water? Water is an essential medium for chemical reactions occurring in our body; it brings nutrients for our body needs; and it takes away wastes produced in our body. Water is constantly lost from our body through sweat, urine and breath. Without regular top-up water, our body can only survive a few days. If we don’t drink enough water to replace the lost, we became dehydrated.

The early sign of dehydration is thirst. If you are thirsty, you are in dehydration. The other common signs of dehydration include: dark yellow coloured urine and not passing much urine when you go to the toilet, headaches, tiredness and feeling lightheaded. How much water do we need a day? We need 1.5 to 3 litres to make up to the water that we loss every day in moderate condition. This is about 8 medium glasses of water. We may need more water during hot weather or physical activity. You can tell if you drink enough of water by the colour of your urine. If the urine is pale straw colour, you have enough water intakes.

There are three layers of the skin. The outer layer contains skin cells, pigment, and proteins. It is the outlook of the skin. It provides a waterproof barrier and creates the skin tone. In this layer there are no blood vessels and the skin cells are nourished by the blood supply of deeper layers.

The skin contains 64% water. Water makes the skin pliable and smooth. Dehydration causes skin wrinkles and is also related to dry, scaly skin and irritant dermatitis. Drink plenty of water to prevent the skin from dehydration. Exposure to cold, wind, sun and low humidity makes the skin dry; this is due to water loss and poor circulation from the skin.

Acupuncture can help increase water and oil content for facial skin. This is proved by a research paper. In this research, two women received five consecutive acupuncture sessions once a week for a month. Water content and oil content of the facial skin were measured and compared before and after the first acupuncture session and before and after the five consecutive acupuncture sessions. The result suggested that cosmetic acupuncture increased the water and oil content of facial skin in a female participant whose water content and oil content were lower before receiving acupuncture (which mean the skin was dry before acupuncture treatment).

References

N. Donoyama, A. Kojima, S. Suoh, and N. Ohkoshi, “Cosmetic acupuncture to enhance facial skin appearance: a preliminary study,” Acupuncture in Medicine, vol. 30, no. 2, pp. 152–153, 2012.

Thursday, 5 April 2018

Suffer from low back pain? acupuncture can help

Back pain is a common condition which affects more than 1 million people in the UK. Back pain can be caused by many factors. But some of the causes cannot be found.

95% of back pain occurs in the lower back. It is defined as non-specific low back pain. Non specific low back pain is tension, soreness and stiffness in the lower back region and the specific cause of the pain cannot be identified. The pain is normally as lasted for more than 6 weeks, but less than 12 months. The pain is persistent or recurrent. Joints, discs and connective tissues in the back may contribute to symptoms. Low back pain affects more than 79% of the population in developed countries. It accounts for 13% absences due to illness in the UK. 35-55 year old are affected most. 90% of the episodes of acute low back pain settle within six weeks, up to 7% of patients develop chronic pain. A study from a study with 5000 adults by the British Acupuncture Council to mark 'Acupuncture Awareness Week' (3rd-10th March 2014) show that almost 80 per cent of people suffer with back pain admit to behaviours that put their backs under unnecessary strain. This study found that almost half of the adults admit to eating on their lap, 40 per cent complain they sit at a desk all day and over a third admit to watching TV or films in bed. When asked about their posture, almost a third also admitted they slouch most of the time.

In the case of treatments for back pain, 74 per cent say they repeatedly use painkillers to deal with their discomfort, which would numb the end symptom and mask the problem but do not address many of the combined underlying causes of back pain rather than addressing the root cause of the problem. Statistics show that 41 per cent of people would only consider acupuncture as a last resort and 88 per cent didn't know the National Institute of Clinical Excellence (NICE) recommends acupuncture therapy for persistent, non-specific lower back pain.

Some patients do turn to complementary and alternative medicine for back pain treatments. What do these patients expect from CAM treatments?

There was a study with semi-structured interviews with 64 individuals receiving massage, chiropractic, acupuncture or yoga for chronic low back pain. The findings included that participants' expectations of treatment outcomes were in four key aspects: pain relief, improved function (including an increase in ability to engage in meaningful activities), improved physical fitness, and improved overall well-being (including mental well-being). Typically, patients had modest expectations for outcomes from treatment.

With 2.3 million acupuncture treatments carried out each year, acupuncture is one of the most popular complementary therapies practised in the UK today. By stimulating different points of the body, acupuncture can be extremely beneficial for back pain, providing long term pain relief and reducing inflammation.

Low back pain with acupuncture treatment

Acupuncture is well known for its effectiveness for back pain. Many research data have provided solid evidence that acupuncture is effective for lower back pain.

NHS recommended acupuncture combined with self-care for persistent low back pain.

Acupuncture alone is effective to relieve back pain. Also acupuncture can be one of the combined treatments offered to patients which reduce the use of medications and improve the outcome. Self care and acupuncture can help release low back pain. This is recommended by NICE guidance as treatment options for persistent low back pain. Cheshire A et al reported their survey based in a primary and community care setting, delivering acupuncture, self management and information to patients with chronic low back pain. They evaluated patient outcomes and experiences of the Beating Back Pain Service (BBPS). The questionnaire is at three time points: pre-BBPS, immediately post-BBPS and three months post-BBPS. There were 80 participants with mean age 47 years. 65% of them were female. Their results showed that pain scores were improved between baseline and post treatment, these improvements were maintained at 3 months follow-up. Patients receiving a combination of acupuncture and self-management sessions produced the most positive results. Patients satisfaction with the BBPS was high. They concluded that combining self-management with acupuncture was most effective, though further consideration is needed to engage patients in self-management. Acupuncture has no severe side effects which can be applied over a longer period of time. The National Institute for Heath and Clinical Excellence guidelines on best practice now recommend offering a course of 10 sessions of acupuncture as a first line treatment for persistent, non specific low back pain.

Effectiveness and acceptance of acupuncture for low back pain

There was a study involved 18000 patients with chronic pain including low back pain. This study showed that the effect of acupuncture was more than placebo. There was a further evidence provided by research from Germany showing that acupuncture is effective for chronic low back pain and acupuncture was highly accepted and had positive effects in patients with chronic low back pain. This was a randomized controlled trial. There were 143 participants with chronic low back pain. 74 patients were offered acupuncture twice a week, while other 69 patients were not given acupuncture as a control. Acceptance of acupuncture, health-related quality of life and pain/symptoms were assessed. The result of the study showed that acceptance of acupuncture was excellent. 89% of the patients would like to have TCM integrated treatment and 83% would have paid for TCM if necessary. Physical functioning, general health, vitality and emotional role were all better in patients with acupuncture treatment compared with control group. Pain relief in acupuncture group was superior to the control group. For instance, pain with sitting/standing, pain upon carrying loads of 10 kg or more and pricking in hands and feet were significantly reduced. Author’s conclusion was that acupuncture was highly accepted and had positive effects in patients with chronic low back pain. Acupuncture can be an effective, well tolerated therapy with no major side events.

Why acupuncture is effective for low back pain?

There are several mechanisms that explained the effectiveness of acupuncture on pain relief. Acupuncture stimulates nerve endings located in muscles and other tissues leading to production of endorphins and other neurohormonal factors. Acupuncture reduces inflammation by releasing vascular and immunomodulatory factors. Acupuncture increases local blood circulation and improves muscle stiffness, joint mobility and swelling. Also how brain and spinal cord processing pain has been altered. In neuroscience, the default mode network (DMN) is a functional network of brain regions that show increased activation during wakeful rest. In patients with low back pain, this DMNconectivity has changed. Acupuncture has been widely accepted for effective low back pain treatment. How acupuncture affect DMN is not clear. Tang et al studied this subject. They used RsfMRI technique to analyse the connectivity of DMN and recruited 20 patients with low back pain and 10 health subjects for controls. They found that there was less connectivity within the DMN in patients with low back pain than healthy subjects, mainly in the dorsolateral, prefrontal cortex, medial prefrontal cortex, anterior cingulated gyrus and precuneus. After 4 weeks acupuncture treatment, patients brain connectivitys were restored almost to the levels seen in healthy controls. Reductions in clinical pain were correlated with increases in DMN connectivity. It can be seen from this data, modulation of the DMN by acupuncture is related to its therapeutic effects.

Standardization of acupuncture points for low back pain

TCM diagnoses and treatment recommendations for specific patients with chronic low back pain vary widely across practitioners. If you go and see a few different acupuncturists, you would get acupuncture at different points. There are no standardized acupuncture points for any conditions. A study has shown that twenty diagnoses and 65 acupoints were used at least once; and only one point UB23 was used for every patient by most acupuncturists. In China standardization of acupuncture points was encouraged to achieve best outcome of the treatment. There was a study compared the efficacy of standardized acupuncture and individualised acupuncture points. In this study up to 15 sessions of acupuncture treatments were offered. The standardized acupuncture was based on the acupuncture intervention from a large multicenter trial previously performed. 78 patients were in the standard acupuncture group and 72 patients were in the individual acupuncture group. Both acupuncture interventions were applied by the same medical doctor specialized in western general medicine (25 years of clinical practice) and trained in Chinese medicine with 20 years' experience in treating low back pain with acupuncture. The result has shown that the average pain severity after 8 weeks and 26 weeks did not differ significantly between both groups. This study has shown the possibility of standardization of acupuncture treatment for chronic back pain patients.

Which acupuncture points are frequently used in lower back pain?

There are over 400 acupuncture points in human body according to Chinese medicine theory. The selection of appropriate acupuncture points is the first step to obtain therapeutic effects. How acupuncturists select acupuncture points? There are three basic principles to select acupuncture points: the first is local acupoints near the area where symptoms occur; the second is distant acupoints along the meridian and the third is distant acupoints based on symptom differentiation. Lee SH et al analysed acupuncture points from 53 studies using modern techniques to extract most commonly used acupuncture points. There were 33 most frequently used acupoints for lower back pain (LBP). The most frequently used acupoints in the treatment of low-back pain were BL23 (51%), BL25 (43%), BL24 (32%), BL40 (32%), BL60 (32%), GB30 (32%), BL26 (28%), BL32 (28%), and GB34 (21%). All local acupoints for LBP are on the Bladder and the Governing vessel especially at the low back position of these meridians. Most of the distant acupoints are on the Bladder and Gallbladder meridians. The acupoints include seven acupoints (BL23, BL24, BL25, BL26, and BL32 as local points and BL40 and BL60 as distal points) on the bladder meridian and two acupoints (GB30 as a local point and GB34 as a distal point) on the gallbladder meridian.

Mechanisms of acupuncture for low back pain

Acupuncture needles are used to treat low back pain. The mechanism of this treatment is still not clear. Why some people respond well while others do not. A study examined changes in lumbar multifidus (LM) muscle function and nociceptive sensitivity after dry needling in patients with LBP and to determine if such changes differ in patients that exhibit improved disability (responders) and those that do not (non-responders). Sixty-six volunteers with mechanical LBP completed the study. Ultrasound measurements and pain algometry of the LM were taken at baseline and repeated immediately following dry needling treatment to the LM muscles and after one week. The percent change in muscle thickness from rest to contraction was calculated for each time point to represent muscle function. Pressure pain threshold (PPT) was used to measure nociceptive sensitivity. Participants were divided into responders and non-responders based on whether or not they experienced clinical improvement using the modified Oswestry Disability Index after one week. Patient responders showed larger improvements in LM muscle contraction and nociceptive sensitivity 1 week, but not immediately, after the treatment than non-responders. The results suggest that there may be lasting and clinically relevant sensorimotor changes that occur in LBP patients that improve with acupuncture needle treatment

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