Techniques to compliment and speed your healing
Gua Sha
Gua Sha is a traditional Chinese bodywork treatment that releases muscle tension, fascial adhesions, and stagnant metabolic waste products, known as “sha” in injured areas. Gua sha is sometimes referred to as “spooning” or “coining” and it has also known by the French name, tribo-effleurage, which translates to “friction-stroking”.
A Gua Sha sessions consist of stroking and “scraping” the skin to stimulate blood flow and healing. Although the technique causes some light bruising, it does not typically hurt afterward and patients report immediate relief from pain and muscle tension. It’s our favorite for certain types of neck and shoulder tension.
Cupping
Cupping therapy works by creating a vacuum within a glass or plastic cup, which is then placed on the skin, drawing tissue into the cup and stimulating the body’s healing processes. This suction increases blood flow, promotes circulation, and may release fascial restrictions, potentially reducing pain, inflammation, and muscle tightness. Cupping has become very popular amongst athletes like swimmer Michael Phelps and many other professional athletes because it speeds healing without medication that can affect performance.
What is the science behind cupping?
Cupping dilates topical capillaries and increases dermal blood flow, which has been proved by numerous studies. Blood vessels in the treated areas by cupping are dilated by release of vasodilators such as adenosine, noradrenaline, and histamine, which lead to increased blood circulation.
Moxa
Moxibustion, a practice in Traditional Chinese Medicine (TCM), works by stimulating acupuncture points with the heat generated from burning mugwort (moxa). This heat enhances circulation, improves the flow of “qi” (vital energy), and promotes healing. The heat stimulation can also trigger biochemical reactions and induce vascular changes.
Moxibustion is often used to address various conditions, including pain relief, digestive issues, immune system support, and fertility challenges, including helping to turn a breech birth.
Moxa can be done via needle top moxa, indirect (pole) moxa, or direct moxa on the skin. Each application has unique benefits.
Potential Mechanisms:
- Local Somatothermal Stimulation (LSTS): This refers to the stimulation of sensory receptors by heat, which can trigger a range of physiological responses.
- Neural Release of Nitric Oxide (NO): Moxibustion can stimulate the release of NO, a molecule involved in regulating blood vessels and muscle relaxation.
- Heat Shock Protein 70 (HSP70): The heat stimulation can induce the expression of HSP70, a protein that plays a role in protecting cells from stress.
- Ischemia-Reperfusion (I/R) Injury Protection: Moxibustion may have a protective effect against damage caused by ischemia and reperfusion (lack of blood flow followed by restoration).
- Moxibustion is often used to address various conditions, including pain relief, digestive issues, immune system support, and fertility challenges.
Read more about these techniques below:
MOXIBUSTION
Compared to acupuncture, moxibustion is usually deemed a secondary practice. In the Niejing, the basis of ancient and modern concepts about acupuncture and moxibustion treatments, only a few sentences are devoted to moxibustion, mostly with mention in passing. As depicted in the book Chinese Acupuncture and Moxibustion (15) the practice of moxibustion is a back-up for the failure of other therapies:
Chapter 73 of Miraculous Pivot [Ling Shu] states, “A disease that may not be treated [is not successfully treated] by acupuncture may be treated by moxibustion.” In Introduction to Medicine [1575 A.D.] it says, “When a disease fails to respond to medication [Chinese herb therapies] and acupuncture, moxibustion is suggested.”
A search for commentary on the history of moxibustion turns up little; the subject has not generated widespread interest, and the quotations above are typically the only reference to the traditional literature. A monograph on artemisia (Aiye Chuan), published around 1500 A.D. by Li Yenwen, was lost; its title is recorded, but nothing is quoted from it, not even in the Bencao Gangmu, published later that century, which carried quotations from his other monograph on ginseng (19). A search for clinical research on moxibustion in the Journal of Traditional Chinese Medicine (English-language edition, published for more than 15 years) revealed very few articles on moxibustion, and nearly all of the articles that mention this technique made use of it as an adjunct to acupuncture therapy. In the very few articles that mention moxibustion alone, the fact that it is “accepted by the patient” seems to be a key point in selecting its use (presumably, acupuncture is not sufficiently comfortable for the patients).
Still, moxibustion is a relatively common practice in China today, and its position in history may not be so poor as might be suggested by the quotes above. As to the use of artemisia for moxibustion, here is what Chinese Acupuncture and Moxibustion has to say:
Artemisia vulgaris is a species of chrysanthemum [it is in the same plant family]. The one produced in Qizhou is known as the best kind for moxa, as the climate and soil is good for its growth. The leaves of Qizhou Artemisia are thick with much more wool [soft fibers]. Moxa cones and sticks made of this kind of artemisia are thought to be the top quality used in moxibustion. In A New Edition of Materia Medica appears the following description: “The moxa leaf is bitter and acrid, producing warmth when used in small amount and strong heat when used in large amount. It is of pure yang nature, having the ability to restore the primary yang from collapse. It can open the 12 regular meridians, traveling through the three yin meridians to regulate qi and blood, expel cold and dampness, warm the uterus, stop bleeding, warm the spleen and stomach to remove stagnation, regulate menstruation, and ease the fetus….When burned, it penetrates all the meridians eliminating hundreds of diseases.” Yang can be activated by the Artemisia leaf for [because of] its warm nature. The acrid odor [spicy fragrance] of the leaf can travel through the meridians, regulate qi and blood, and expel cold from the meridians, and its bitter nature resolves dampness. As a result, it is used as a necessary material in moxibustion treatment.
Artemisia leaf is also selected for its ability to burn slowly and project heat through the wool in a gentle manner. But the important thing to note in this context is that this description is not a simple depiction of applying heat: it is about applying artemisia specifically. Unless this is understood to be entirely spiritual, in the sense that something mysteriously travels from the mugwort into the body, it must be understood that some of the mugwort vapors and smoke have their effect by entering the body, either through the skin where the moxa is burned or through breathing the fumes, or both. The heat is also important, but, if one is to believe the traditional sources, it is not the sole function. According to the authors of Manual of Dermatology in Chinese Medicine:
Moxibustion is an important and perhaps underutilized therapeutic method in traditional Chinese medicine. It may be used alone or in combination with other modalities, such as acupuncture….This method involves the burning of moxa on or above the skin at the location of specific acupoints, or on or near the lesion [to be treated] itself. The heat of the cauterization, as well as the properties of the moxa itself, serve to warm the qi and blood in the channels, expel cold and dampness, restore yang, and, in general, help to regulate the organs and restore health.
Detailing the functions of moxibustion, Chinese Acupuncture and Moxibustion (15) says that it is used:
- To warm meridians and expel cold. Abnormal flow of qi and blood in the body usually results from cold and heat. Cold causes obstructed flow or even stagnation of qi, and heat results in rapid flow of qi. Normal heat activates blood circulation and cold impedes its smooth flow. Since stagnation of qi and blood is often relieved by warming up the qi, moxibustion is the right way to generate the smooth flow of qi with the help of the ignited moxa wool. In Chapter 75 of Miraculous Pivot it says: “If stagnation of blood in the vessels cannot be treated by warming up with moxibustion, it cannot be treated by acupuncture.” In Chapter 48 of Miraculous Pivot it states, “Depressed symptoms should be treated by moxibustion alone, because depression is due to blood stagnation caused by cold, which should be dispersed by moxibustion.”
- To induce the smooth flow of qi and blood. Another function of moxibustion is to induce qi and blood to flow upward or downward. For example, moxibustion is given to yongquan [KI-1] to treat the disorders caused by excess in the upper part and deficiency in the lower part of the body and liver yang symptoms due to upward flowing yang qi so as to lead the qi and blood to go downward….If the disorder is due to deficiency in the upper portion and excess in the lower portion of the body and due to sinking of qi caused by deficiency, such as prolapse of the anus, prolapse of the uterus, prolonged diarrhea, etc., moxibustion to baihui [GV-20] may lead yang qi to flow upward.
- To strengthen yang from collapse. Yang qi is the foundation of the human body. If it is in a sufficient condition, a man lives a long life; if it is lost, death occurs. Yang disorder is due to excess of yin, leading to cold, deficiency, and exhaustion of the primary qi, characterized by a fatal pulse. At this moment, moxibustion applied can reinforce yang qi and prevent collapse. In Chapter 73 of Miraculous Pivot it says, “Deficiency of both yin and yang should be treated by moxibustion.”
- To prevent diseases and keep healthy. In Precious Prescriptions appears the following description: “Anyone who travels in the southwest part of China, such as Yunnan and Sichuan Provinces, should have moxibustion at two or three points to prevent sores or boils and to avoid pernicious malaria, epidemic diseases, and pestilence. It is often said, “If one wants to be healthy, you should often have moxibustion over the point zusanli [ST-36].” In Notes on Bian Que’s Moxibustion, it says, When a healthy man often has moxibustion to the points guangyuan [KI-4], qihai [KI-6], mingmen [GV-4], and zhongwan [KI-12], he would live a very long life, at least one hundred years.”
The relationship of moxibustion to the herbal material used for moxa wool depends on the technique. For example, when moxa cones are burned on the end of acupuncture needles, the constituents of the moxa do not interact with the skin and the local effect is that of transferring heat to the acupoint. When a moxa pole is used, there is some transfer of active constituents to the skin, but not much; the effect is still mostly heat, but to a broader area. When the moxa cone is burned directly on the skin, active constituents are transferred to the skin. This latter method was the most commonly used traditional approach, as best as one can tell from the old literature. When moxa is burned on top of another herbal material, such as a slice of ginger or garlic, cake of aconite, or mound of salt or powder of herbs in the navel, the heat will drive some of the ingredients of the interposing herbal material into the skin, but little of the moxa wool ingredients will penetrate. Fresh ginger, one of the commonly used interposing materials, contains compounds similar to borneol and camphor (small holes in the slice of ginger or slice of garlic permit a little of the moxa vapors to penetrate). Of course, with all moxibustion techniques, the smoke and vapors from the moxa are ultimately inhaled. The modern smokeless moxa poles are intended to eliminate this otherwise sure route to getting moxa ingredients internally, and might defeat part of the therapeutic action. The Chinese technique of applying moxibustion for an extended period of time (up to 30 minutes for a treatment session), assures that the patient inhales a substantial amount of the vapors and smoke.
The different styles of moxa application and the method of Keeping-fit Moxibustion (the fourth application listed above) was elaborated by Yuan Liren and Liu Xiaoming (16), though with reliance on different points, namely shenque [CV-8], zhongwan [CV-12], yongquan (KI-1], and zusanli [ST-36], the latter point was mentioned above and is a standard for many acupuncture and moxibustion treatments. According to the authors, these points are selected and treated as follows:
Zusanli [ST-36]: Frequent moxibustion on zusanli can invigorate the spleen and stomach, assist in digestion, and hence, strengthen the body and slow down the process of aging. Some ancient experts advocated the use of scarring moxibustion, placing moxa wool directly on the skin over the point so that a scar is formed after the local skin has developed a boil with pus. Constant application of scarring moxibustion will maintain the moxibustion boil, and this will help to strengthen the body and prolong life. Another similar method, known as hanging moxibustion, is composed of hanging an ignited moxa stick 3-7 centimeters over the point without touching the skin for 5-10 minutes.
Shenque [CV-8]: Frequent moxibustion on this point can replenish qi and strengthen the body; it is especially suitable for the middle-aged and elderly. The particular procedure of this kind of moxibustion is as follows: put some salt on the navel, knead some moxa wool into the shape of a cone to be ignited and placed on the salt for moxibustion. The size of the moxa cone should vary with the individual conditions. For people of strong constitution, use big cones in the size of a broad bean and for those of weak constitution, use the middle-sized cones as big as a soybean or use small cones in the size of a wheat grain. The burning up of one moxa cone is referred to as one zhuang. Moxibustion on shenque point requires 7-15 zhuan g .
Zhongwan [CV-12]: This point is an important point for reinforcement, capable of strengthening the spleen and stomach. Both moxa stick and moxa cone are advisable for moxibustion on this point, the duration of which may last 5-10 minutes.
Yongquan [KI-1]: Frequent moxibustion at this point can strengthen the body and contribute to longevity, for it replenishes the kidney and invigorates yang. When using moxa sticks for moxibustion, it should last 3-5 minutes, and in the case of using moxa cones, 3-7 cones are usually needed each time.
The authors state that the duration of moxibustion should be at least 3-5 minutes, but not more than 10-15 minutes. A relatively longer duration of treatment is indicated for recovery from a serious disease or injury to recapture good health, in autumn and winter, on points of the abdomen (i.e., CV-8 and CV-12), and when treating young and middle-aged adults. Relatively shorter duration of treatment is indicated for simple health maintenance and longevity promotion, for spring and summer treatments, when applying moxibustion to the limbs (i.e., KI-1 and ST-36), for the aged and for children. They caution that:
The aim of strengthening the body and achieving longevity cannot be achieved by just applying moxibustion once or twice, for it requires persistence for a long time. This does not mean that one should receive moxibustion every day. For the purpose of convalescence for the weak and sick, the moxibustion may be applied once every 2-3 days in the early stage; yet for reinforcement of the body or longevity, it should be once a week in the early stage. And when it has shown some effect, the frequency can be reduced to once a month, and later, once or twice every three months, or even once or twice a year. So long as the practice is persisted in, good effect is sure to ensue.
A treatment along these lines was described by Song and Zhu (17) in one of the few articles on moxibustion in the Journal of Traditional Chinese Medicine. They treated 97 patients with gastric spasms or intestinal spasms with moxibustion, relying primarily on the abdomen points CV-8 (along with ST-37 for intestinal spasm) and CV-12 (along with ST-34 for gastric spasm). The secondary points surrounding ST-36 were picked because of the intent to treat an acute symptom, but the function is similar. The authors report that nearly all the patients had their abdominal pain alleviated with one treatment. The technique used was:
The moxa roll was ignited and placed over the selected points to produce a comfortable warm feeling. When the heat became excessive, the moxa roll was moved around the points or a little higher to avoid burns. A piece of gauze could be laid over the point to protect the skin from accidental injury. 30 minutes constituted one session of treatment.
Today, especially in the West, herbal moxibustion is sometimes substituted by heat lamps or other techniques that eliminate the artemisia altogether. This may change the functions of moxibustion in a way that is not known. Also, many traditional moxa specialists believed that blistering of the skin was essential to the success of moxibustion when treating serious ailments, much the way that getting the qi reaction to needling was deemed essential to getting success with acupuncture therapy. This method is even mentioned in relation to Keeping-fit Moxibustion, which is for preventive health care. Such intensive moxibustion is avoided in the Western practice, which follows more closely the method used for the gastric and intestinal spasm treatments, though most Westerners use very brief rather than prolonged moxa therapy (in the study mentioned above, the duration of treatment was about 15 minutes per point at two points to yield a 30 minute moxa session). One theory of the effects of moxibustion and acupuncture is that the local tissue damage (twisting of nerve fibers when stimulating acupuncture needles, extended cellular damage by the intense heat of moxibustion) initiates a non-specific healing reaction that can have effects throughout the body. Modern techniques of acupuncture and moxibustion therapy may rely, instead on mechanisms of stimulation that do not depend on tissue damage. However, it must also be recognized that some modern techniques may do little more than comfortably warm the skin and help induce general relaxation.
An additional impact of moxibustion may be to help sterilize the atmosphere of the rooms in which it is being used. In China an incense made of artemisia and atractylodes (cangzhu), when burned in an outpatient operation room, would reduce the bacterial count in the air. It also apparently inhibited viruses. According to Chinese evaluations, it could be used in kindergartens and nurseries to reduce the transmission of diseases, including chicken pox, mumps, scarlet fever, common cold, and bronchitis. Thus, when used in an acupuncture clinic, the smoke from moxibustion might help to prevent transmission of disease from one patient to another, which is especially important when dealing with immune-compromised patients.