Counter-stimulation, Acupuncture & Pain Relief

[See video above] New technologies for Virtual Reality, as evidenced by Snow World, add fuller dimension to the evolving idea of pain relief.

The idea of counter stimulation – where sensory stimulation reduces our perception of pain, either locally or distally – is not new. We do it all the time, clenching our faces in pain or wriggling our toes when the masseur presses down hard at one spot. It’s instinctive for most of us to rub our bruises as if that act of rubbing takes the pain away. But it does – most of the time – until we stop rubbing or putting pressure on the spot. And remember how you would slap that itch away.

Today, we understand it as a crowding out of pain, where we interfere with the sensation of pain by creating other sensations that our sensory nerves detect and send to the brain. These sensations may include different types of touch (rubbing, pressing, slapping) or different temperatures (hot, cold). That’s how it works, but let’s move on to review some approaches developed through the centuries.

Traditional approaches: Massage and Acupuncture as Counter-stimulation

One would postulate that massage and acupuncture probably came about as described above, when parts of the body that were painful were rubbed to ease the pain. These points – called A-shi points – are still indicated in massage or acupuncture treatment, and we understand intuitively that most times it makes sense to stimulate the spot that is painful. The pricking of the skin with a needle is understood to give this effect.

But I think it’s often more than this. Rubbing your bruised arm is not just counter-stimulation – it may also relax the muscles by creating warmth, or help disperse chemical mediators in the area. In a similar way, the effect of acupuncture is much more. Some say it causes the brain to release enkaphalins (endorphins) or regulates the release of neurotransmitters as serotonin, dopamine et al. Some points certainly have more marked endocrine effect, and may cause a variety of changes in our body chemistry, dilating vessels and bringing in the healing salvation of blood to the area, or boosting the production of hormones that the body is in need of but not making. It runs a large gamut, and may not be as easy to pin down as we’d like.

Gate theories are also used to explain the effect of acupuncture on pain perception and on motor function.

  • Gate control theory sees pain perception as controlled by a gate between the place you’ve been pricked (locatin of impulse generation) and the brain. We know that pain travels via sensory nerve fibers to be relayed to the brain. But this gate closes up and blocks off the transmission of pain IF the pain impulses are getting through too much too quickly. The thin C fibers have been found to exhibit such a “gate” function.
  • Gates may not just exist in sensory fibers. When implicated in motor fibers, stimulation of the fibers – whether by massage, acupuncture or exercise – reopens a closed gate, hence enabling motor impulses from the brain to reach muscles or internal organs. This is not just useful for treating impaired muscle function, but may also be helpful when we think that nerves leading to certain organs are “blocked.”

Traditional Approaches: Counter-irritants

I put counter-irritants in a different category, because whether correct or otherwise, I think of counter-irritants as liniments or ointment that are rubbed on painful parts of the body.

In general, application of a counter-irritant will not only crowd out the primary course of pain (e.g. arthritis) but will also induce inflammation. Inflammation involves vasodilation, blood moving in with oxygen to nurture the local area and with neutrophils and macrophages to get rid of any byproducts, and perhaps other chemical mediators that will assist in healing.

So, the idea here is that inflammation inadequate with chronic pain. We may thus need to induce inflammation – in moderation – to aid healing.

This may be over-simplifying it, but counter-irritants are:

  • analgesic: by crowding out the primary source of pain.
  • vasodilating: by inducing benevolent inflammation.

This would be a good explanation for why moxibustion, baguan and gusha are TCM treatments that may be both analgesic and beneficial to the healing process.

Comparative Take on Bao He Wan

“保和丸,治一切食积。” (Bao He Wan, to treat all food stagnation.)

Bao He Wan is an herbal formula created by Zhu Dan Xi (朱丹溪). It is documented in his book 《丹溪心法》as treatment for what is termed food stagnation (食积). Especially useful if one feels a bloating sensation in the stomach after a meal, a sign of possible indigestion. We already have the TCM explanation for this formula make-up. It would hence be more useful for readers if we compare the ingredient of Bao He Wan with their biopharmaceutical peers.

The original formula is made up of three broad categories of herbs. The first are the digestives, akin to the enzymes e.g. protease, lipase, amylase that we use to aid digestion. Shan Zha (山楂), also known for helping weight loss and treating high blood lipids, is known traditionally to digest meats. Lai Fu Zi (莱菔子) is the seed of radish, and is known for breaking down wheat – remember, this is usually wheat in bread and noodles. Last of all, we have Shen Qu (神曲) which if simplified is a cocktail of enzymes.

In today’s formulations of Bao He Wan, we also see other herbs being included, most common of which is maiya (麦芽). Zhishi (枳实)and baishu (白术) are also wont to be thrown into the mix.

“人有食积,必生痰湿。” (He who is wrought with food stagnation, will produce phelgm and damp.)

In TCM, there is a saying that when there is food stagnation, phlegm-stagnation will appear. Which is why the second group of is erchen tang (二陈汤) but without licorice.

“食积日久则易生热。” (Food stagnation over time will generate heat.)

There is also another idea that the long-term result of food stagnation is heat generation. This is understandable, as in the case of chronic gastritis, where there is slight inflammation of the stomach lining. The original formula uses lian qiao (连翘) in response. These days, the solution would be the use of antacids like aluminium hydroxide and magnesium hydroxide.

That said, there is an obvious difference between the use of lian qiao as an anti-inflammatory and the use of antacids to neutralize excess acid production. One can read up on content by alternative medicine practitioners who believe that the problem is not excess acid production in the stomach; instead they believe it is the lack of acid production.

As mentioned above, qi regulators like houpu (厚朴) and zhishi (枳实) are thrown in to regulate qi and take away any bloating. While there is not clear connection, we can liken this to the use of anti-flatulent medications like simethicone (西甲硅油) or to gastroprokinetics like mosapride (莫沙必利) or cisapride (西沙必利).

Why Platycodon (桔梗) is a ship that carries the other herbs upward

“诸药舟楫,载药上行”

As a tradition, platycodon is used in many illnesses that are located at the chest and upward. For example: cough with alot of phlegm, a sore throat, or even lung abscesses. In many formulae, its role is as a carrier, to bring the other herbs to the chest area.

One modern explanation for this: Platycodon contains many saponins, which put simply are soap-like compounds. These saponins come in contact with a big part of the respiratory tract as well as the digestive tract (of course). And assuming (I don’t know yet) the action of saponins ends at the stomach area, then it is restricted to the chest and upward.

One example of its use at chest level: One particular type of saponin, platycodin (桔梗皂苷), can stimulate the mouth, throat and stomach lining upon contact, and this stimulus is passed on as a reflex, increasing bronchial mucus membrane secretions. This thins phlegm, explaning platycodon’s use as an expectorant.

Platycodon is also a natural aspirin: It is an anti-inflammatory pain-killer that also brings down your temperature. Small wonder its use in A Treatise on Warm Diseases (《温病条辨》). Go look at xing su san (杏苏散) and sang ju yin (桑菊饮) and the host of other cold, cough and flu formulas. It is seldom that platycodon is left out of the equation when treating pulmonary conditions.

Can natural statins damage your liver?

Some time back, over a dinner conversation, someone brought up the topic of Hongqu (红曲), also known as Red Yeast Rice Extract. Hongqu has now been popularized as a natural statin, useful for the prevention or treatment of high blood cholesterol (高血胆固醇). Almost immediately, the topic moved on to the danger of using Chinese medicinal herbs, citing the case where someone suffered liver damage eating Hongqu. So what really went wrong? Is Hongqu really that harmful?

The enzyme, high blood cholesterol and LDL:

In the liver exists this enzyme called HMG-CoA reductase. If left on its own, this enzyme is able to create cholesterol from HMG-CoA. In many older people, there is a tendency to see excess cholesterol clogging up the blood vessels.

High blood cholesterol levels is related to high blood LDL levels. LDLs carry cholesterol from the liver (where it is mainly produced) into the blood vessels for use in other parts of the body. Therefore, when there is high blood cholesterol, there is usually high blood LDL. Usually this is a sign that your blood vessels are clogged up by cholesterol.

Statins, their effect and side effects:

Different statins include fluvastatin, atorvastatin, lovastatin and simvastatin. Available commercially, pharmaceutical statins work by inhibiting the action of the enzyme HMG-CoA reductase. When the enzyme is inhibited, HMG-CoA can no longer become cholesterol. This reduces the amount of cholesterol produced by the body. LDL is also reduced as a result.

That said, statins are broken down in the liver, hence increasing its workload. Liver damage is a possible side effect.

Important Information:

 

  • Side effects include dizziness, heartburn and muscle weakness.

 

 

 

  • Statins increase the risk of heart attack, unstable angina, and stroke is you stop taking it suddenly.

 

 

 

  • Studies have found that grapefruit juice enhances level blood levels of these statins, with the associated side effects. Therefore, you should be careful when taking grapefruit juice with statins.

 

 

 

  • Statins may lower the production of Coenzyme Q10 in the body. Coenzyme Q10 provides energy for every cell, and is crucial especially for helping our heart beat. Therefore, levels of Coenzyme Q10 are usually supplemented when using statins.

 

 

Hongqu as a natural statin:

Hongqu contains monacolins, compounds that are similar in structure to statins. Monacolins inhibit the same enzyme inhibited by statins. Hongqu is also called a natural statin. You may ask, how could it have caused liver damage if it is a natural herb?

It could have been used together with prescription statins like simvastatin and lovastatin. It could also have been due to misuse by the patient. More likely, the patient was not aware that even Hongqu overworks the liver despite being a natural product.

The lesson to be learned:
Yes, even natural statins are able to damage your liver. This is because of the way statins work.

是药三分毒.

The person who blamed Hongqu for causing liver damage must be aware that prescription statins are just as harmful. In the end, it is more a matter of how you use the medicines you have. Medicine (药) is synonymous to poison (毒) in Chinese Medicine. The lesson to be learned is to respect medicine and to use it with care.

By the way, there is an ongoing debate now in the States on whether or not to give Hongqu the status of a prescription drug. Of course the drug companies don’t want that to happen, since synthetic drugs like lovastatin are already making them alot of money.