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Archive for the ‘acupuncture and fertility’ tag

Long Island IVF: New Acupuncture Program Symposium-FREE Event!

By Tracey Minella

April 22nd, 2016 at 9:02 am

Long Island IVF… the practice that brought Long Island its first IVF baby, first Donor Egg baby and First baby from a cryopreserved embryo… is pleased to announce another major “first” on Long Island:

We are the first infertility practice with a Reproductive Endocrinologist who is also a Traditional Chinese Medicine (TCM) practitioner and certified acupuncturist.

After 30 years of creating babies, Long Island IVF co-founder and reproductive endocrinologist, Dr. David Kreiner, went back to the classroom to study TCM and become a certified acupuncturist.

Motivated by a desire to find complementary holistic approaches to enhance today’s best Western medical technologies, Dr. Kreiner is now applying that acupuncture training in the IVF procedure room, both pre- and post-IVF transfer. IVF patients… especially those for whom Western medicine alone has not yet produced a baby…may benefit from adding this ancient therapy. The treatment is available exclusively to all LIIVF patients.

Want to learn more about how this exclusive, yet very affordable, natural therapy might help increase your chances of conceiving?

 Register to attend when we launch this special program on Thursday, May 12, 2016 at 6:30 pm at our Melville office at 8 Corporate Center Drive, Melville, New York. The seminar is free and light refreshments will be served, but seating is limited and seats are going fast, so pre-registration is required.

There will be presentations on several topics from several of the regions experts in acupuncture, including:

1- Western Medicine approach to Infertility – Dr. David Kreiner, MD REI and NYS Certified Medical Acupuncturist, Long Island IVF

2- Acupuncture Diagnosis and How Treatment is Individualized – James Shinol LAc

3- Fertility Enhancement with Diminished Ovarian Reserve-Improving Ovarian Stimulation – Dr. XinJuan Yang, Ph.D,MD (China), LAc

4- Fertility and Diet – Roberta Siegelson, LAc

5- PCOS and acupuncture – Dr. Christine Bauer, DC, LAc

6- Enhancing Uterine Receptivity –Dr. Ping Zhu, Ph.D, MD (China), LAc

7- Acupuncture to Minimize Risk of Miscarriage –Mike Berkley, LAc

8- Japanese Acupuncture  – James Vitale, LAc

 

 

We look forward to seeing you there. Please contact Lindsay Montello, Patient Services, at 631-752-0606 or LMontello@liivf.com with any questions.

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Are you coming to the launch of the Acupuncture Program?

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Long Island IVF-WINNER: Best in Vitro Fertility Practice 2015 AND 2016

It is with humble yet excited hearts that we announce that Long Island IVF was voted the Best In Vitro Fertility Practice in the Best Of Long Island 2015 and 2016 contest…two years in a row!

The doctors, nurses, embryologists, and the rest of the Long Island IVF staff are so proud of this honor and so thankful to every one of you who took the time to vote. From the moms juggling LIIVF babies… to the dads coaching LIIVF teens…to the parents sending LIIVF adults off to college or down the aisles… to the LIIVF patients still on their journeys to parenthood who are confident in the care they’re receiving…we thank you all.

We love what we’ve gotten to do every day more than 28 years…build families. If you are having trouble conceiving, please call us. Many of our nurses and staff were also our patients, so we really do understand what you’re going through. And we’d like to help. 631-752-0606.

 

 

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Improving IVF Success With Acupuncture

By David Kreiner MD

March 3rd, 2016 at 11:08 am

image credit: Praisaeng/ Freedigitalphotos.net

I have been studying and practicing fertility treatment since 1985.  Over the past 31 years, I’ve witnessed first-hand the enormously improved success we have been able to achieve with advancements in in-vitro fertilization (“IVF”).  Every day now, people we previously thought could never be helped to conceive are having babies as a result of today’s state-of-the-art IVF technology.  However, successful as we have been, there are those who remain unhelped and still in need despite modern technology and medicine.  For those, I went back to school to study Traditional Chinese Medicine (“TCM”) and acupuncture.

 

TCM has been successfully used for nearly all health problems since before recorded history.  In fact, approximately 2400 years ago the ancient Chinese medical text, Yellow Emperor’s Canon of Internal Medicine, was written dealing with the relationships among the internal organs and with the concepts of yin and yang as applied to medicine.  In TCM, the yin and yang principle proposes that the bodily organs are interdependent and support each other in harmony.  Disease is defined as a loss of this state of balance within and among the organs.  Treatment with TCM is based on the restoration of the body’s natural harmony and rebalancing of all the organs.

 

Applying TCM to conventional Western medical diagnosis mixes different worlds without a common language.  The science of TCM is based on the flow of Qi (the body’s life energy) that connect the organs through channels and runs throughout the body.  Deficiencies and stagnations of this Qi arising from the different organs result in patterns of symptomatology– including the inability to conceive.  Treatment is individualized based on the unique patterns that are evident in each patient.  These symptoms and patterns are elucidated upon taking the patient’s history and performing a physical examination.

 

Integrating TCM with state-of-the-art Western medicine involves focusing on these patterns and  connections that help us filter each patient’s story and emerge with a clear map of how to use all the tools of medicine… including the most effective TCM and high-tech Western medicine.

 

Though the West was first introduced to acupuncture and TCM when President Nixon visited China, it was not until 2002 that the American Society for Reproductive Medicine (“ASRM”) took notice when a published article in Fertility and Sterility showed that pre- and post- transfer acupuncture increased pregnancy rates.

 

The Manheimer review published in Human Reproduction in June 2013 showed statistically improved success when acupuncture was used as adjunctive therapy in IVF programs that had lower pregnancy rates.  Recently, Dr. Shahar Lev-Ari from Tel Aviv University Sackler School of Medicine reported when combining IUI with TCM treatments, 65.5% of a test group of 29 women between ages 30 and 45 (average 39.4) were able to conceive, compared with 39.4% of the control group of 94 women between ages 28 and 46 (average 37.1) who received no herbal or acupuncture therapy.  The TCM treatment included weekly acupuncture and Chinese herbs.

 

At ASRM 2015, Dr. Paul Magarelli presented a study he performed from his program in Colorado demonstrating significantly higher pregnancy rates when acupuncture was initiated at least 6 weeks prior to embryo transfer and included pre- and post- transfer treatments.

 

How does acupuncture help fertility?  From a Western perspective, acupuncture’s successful treatment of stress is effective to improve fertility mostly by improving hormonal function.

There is evidence that acupuncture also increases blood flow to the reproductive organs and helps balance the endocrine system.

 

If we are to assume that combining TCM with modern reproductive medicine optimizes a patient’s success, then how can we best help our patients?  At Long Island IVF we work with some of the most qualified fertility acupuncturists on Long Island and, in addition, offer TCM and acupuncture on-site in the Melville office including pre- and post- transfer.

 

As a certified acupuncturist and reproductive endocrinologist with over 30 years of experience in IVF, I feel I am uniquely qualified to offer our patients the most effective fertility treatment that includes the best that Western medicine has to offer as well as TCM and acupuncture.

 

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Do you think adding acupuncture to your treatment plan could be beneficial?

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Long Island IVF-WINNER: Best in Vitro Fertility Practice 2015 AND 2016

It is with humble yet excited hearts that we announce that Long Island IVF was voted the Best In Vitro Fertility Practice in the Best Of Long Island 2015 and 2016 contest…two years in a row!

The doctors, nurses, embryologists, and the rest of the Long Island IVF staff are so proud of this honor and so thankful to every one of you who took the time to vote. From the moms juggling LIIVF babies… to the dads coaching LIIVF teens…to the parents sending LIIVF adults off to college or down the aisles… to the LIIVF patients still on their journeys to parenthood who are confident in the care they’re receiving…we thank you all.

We love what we’ve gotten to do every day more than 28 years…build families. If you are having trouble conceiving, please call us. Many of our nurses and staff were also our patients, so we really do understand what you’re going through. And we’d like to help. 631-752-0606.

 

 

 

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ASRM 2015: Looking Back and Moving Ahead “We Could Always Do More and Do Better”

By David Kreiner MD

October 18th, 2015 at 12:58 pm

It was fitting that this year’s national infertility meeting, the ASRM was held in Baltimore, the city where the recently deceased Dr. Howard W. Jones Jr. first trained and rose to prominence in the field of reproductive medicine.  In the 1950′s and during his career at Johns Hopkins, he was involved in the controversial biopsy of cervical cancer patient, Henrietta Lacks, which led to the most widely utilized and researched cell line of all time.  Thereafter, he became an expert in genetic disorders and reproductive developmental issues that led to his opening the first transgender surgery clinic.  Remarkably, however, “Dr. Howard” (as we students called him) is best known for work he performed after his retirement from Hopkins when he moved to Norfolk and started the first IVF clinic in the Western Hemisphere resulting in the birth of the country’s first IVF baby, Elizabeth Carr, in 1981.

 

My first ASRM (called the American Fertility Society at the time) meeting in 1983 was a showcase of this brand new technology of IVF despite a success of 10% in the best clinics. Reproductive surgery was still more successful than IVF so there were presentations by the premier microsurgeons, laparoscopists and hysteroscopists who were demonstrating the latest advances that were becoming available as instrumentation had improved and laser had become a tool of the reproductive surgeon.  IVF was performed laparoscopically and ovarian stimulations were being performed with some variation of human menopausal gonadotropin, Pergonol, derived from the urine of menopausal women and Clomid.

 

In 2015, we reviewed the impact of social media in the opening presidential lecture urging members of the Reproductive Science community to spread the word about reproductive technology advances and utilize social media tools to educate the public.

 

In this meeting, it was now recognized that the LGBT community needed to become a special interest group within the ASRM with focus on alternative family-building that was available not just to lesbian couples but to gay male couples and transgenders.

 

With the successful fertilization and subsequent pregnancies achieved through egg freezing, fertility preservation for women undergoing cancer treatment, gender reassignment or aging prior to a time when they are ready for motherhood is now available. The technology of egg freezing thrusts upon women important new options to be considered (often on an urgent basis) when preparing for chemotherapy, radiation, hormone therapy or surgery… or simply before aging does irreversible damage to one’s fertility.

 

There was an Acupuncture symposium that presented research demonstrating improved success with IVF when utilized twice a week for at least 4-5 weeks prior to retrieval, before and after transfer.  The use of the mild male hormone, DHEA, was discussed in yet another symposium as a potential benefit to patients with diminished ovarian reserve to optimize number of eggs and embryos and improve pregnancy rates.

 

Elective freezing of embryos to transfer in a non-stimulated cycle and embryo-banking combined with complete genomic sequencing of the embryos to selectively transfer only healthy embryos has demonstrated improved success of IVF. And aside from the increased cost and time involved, it appears to be the ideal approach to IVF today.

 

I think Dr. Howard would be happy with these developments in the field and the direction the society is going both towards a more efficient and safer treatment and to widening its scope to be inclusive of the LGBT community.  Though typical of Dr. Howard, he always thought we could do more and better.  Weeks before his death, he called my friend and former fellow, “Richard S”.  He complemented him on his great work but complained to Richard that he wasn’t measuring some hormone or factor that Dr. Howard thought needed to be checked in Richard’s research…

We have come a long way in the 32 years that I have been active in ASRM. I’m proud that Long Island IVF has always been on the cutting edge of reproductive medical technology with programs and practices already existing for this year’s most popular ASRM topics, including social media, LGBT-focused and friendly alternative family-building, egg-freezing, complete genomic sequencing aka PGS (pre-embryo genetic screening), and acupuncture. Let it never be said that the work is done and that we are satisfied with the status quo.  As Dr. Howard would say, “we could always do more and do better”.

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Have you considered using any of these latest technologies or programs in your family-building plans?

 

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Age and Fertility

By David Kreiner MD

February 2nd, 2015 at 4:23 pm

 

credit: photostock/free digital photos.net


You’ve heard the “Reproductive Bell” toll and may question “Is it real?”…

You see celebrities getting pregnant well into their 40’s and think “Then why can’t I?” So, is your reproductive clock as critical as modern doctors say?

I have come across fertility advice from non-physician practitioners, such as acupuncturists and Chinese herbalists, who encourage their patients to “question the Western dogma” when it comes to age and fertility. They claim the effect of aging and fertility is “exaggerated by the Medical profession and can be overcome with a shift in an individual’s health and lifestyle”.

Unfortunately, this advice comes without any cited research or statistics in support of it.  According to the Society of Assisted Reproductive Technology, as published on SART.org, a review of the 2012 national statistics, those most recently published of IVF cycles started, the age breakdown for IVF live birth rates are the following:

 

Age <35= 40.2%

 

Age 35-37=31.3%

 

Age 38-40=22.2%

 

Age 41-42=11.8%

 

Age >42=3.2%

 

It is true that a woman’s health and physiology gets worse as she gets older.  Some of these non- physician practitioners argue that perhaps if this can be improved then the diminishing fertility commonly seen with aging can be reversed. But though improving a woman’s general health may help it is not sufficient in most cases.  Fertility rates decrease with increasing age in large part because there is an increase in genetic abnormalities found in gametes (eggs and sperm) as patients (women in particular) age.  This is the result of long-term environmental exposure to toxins, in addition to the increased likelihood of genetic damage over time.  Miscarriage rates increase with age for the same reason in large part due to the greater likelihood of embryos having chromosomal abnormalities.

Many women as they age also will experience a significant drop in their ovarian activity, referred to as diminished ovarian reserve.  This activity can be assessed by your physician with a blood level of Anti Mullerian Hormone (AMH) and day 3 FSH and estradiol levels.  Women with lower AMH levels and elevated FSH in the presence of a normal low estradiol have fewer ovarian follicles, and hence eggs, that will respond to ovarian stimulation.  Since the likelihood of these eggs being genetically normal is less, then fertility is reduced and the probability of IVF and other fertility treatments resulting in a live birth becomes significantly lower.

The challenge to any practitioner dealing with an aging patient attempting to conceive is to optimize their patient’s chance to have a healthy baby which optimally would include an integration of multiple modalities.  Therefore, ideally a physician specially trained in the fertility process (a Reproductive Endocrinologist), should implement state-of-the-art Western therapies with a complementary holistic approach that aims to shift their patient’s health and fertility.  These holistic approaches include diet and lifestyle changes as well as fertility-directed acupuncture and herbal therapy treatments.

Lifestyle changes that may improve fertility primarily include those that reduce stress and improve diet and activity.  Stress at work, at home, and with family and friends can create pathology from both Eastern and Western perspectives.  Diets that do not support adequate blood production or create Eastern patterns of cold or heat can affect fertility.  Excesses or deficiencies of particular foods…such as dairy, fat, or grains… can create imbalances or pathology that may affect fertility or result in obesity or malnutrition which also impact reproduction.

Inactivity may impair fertility. Therefore some level of exercise, combined with an improved diet directed at improving fertility, stress reduction techniques, acupuncture, and supplements (which may include Chinese Herbs as well as Western supplements) will optimize your chances of successfully building your family.

The first step is to seek help from a reproductive endocrinologist skilled in state-of-the-art fertility therapies who can coordinate a program which is ideal for you. But if you are hearing the “Reproductive Bell” tolling, it is important to take that first step soon, because, while these many complementary approaches can optimize your fertility, they may not be enough to overcome the reality of the negative effect of advanced age in fertility.

Long Island IVF offers complementary holistic approaches to achieving pregnancy (See our Mind-Body Program http://www.longislandivf.com/mind_body.cfm ) as well as a well-respected Donor Egg Program http://www.longislandivf.com/donor_programs.cfm  with no wait for pre-screened, multi-ethnic donor eggs, or Donor Embryos.

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Has the increased visibility of older celebrity moms getting pregnant made you think you have more time? Have you considered combining Western and Eastern medicine in your family-building treatment?

 

 

http://www.freedigitalphotos.net/images/Younger_Women_g57-Young_Woman_Holding_Clock_p49428.html

 

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Infertility and TCM (Part 8): The Promise of Blending Western and Eastern Medicine

By David Kreiner MD

June 10th, 2014 at 6:34 pm

 

 

image courtesy of stuart miles/freedigital photos.net

As I approach the midway point of my second semester of studying Traditional Chinese Medicine (TCM) I realize that I believe much more strongly in the effectiveness of these ancient healing arts.  I have begun to work on recharging the Qi in my body by performing Qigong exercises and improving my abdominal breathing.  I stimulate my Qi meridians throughout my body daily to improve the flow of Qi in my body.  I even have performed some acupuncture on myself that I am convinced has helped relieve some minor arthritic pain as well as other symptoms that I have developed over the years.

I foresee a time when many physicians will utilize acupuncture to fill some voids that I have witnessed in Western Medicine.  Patients with aches and pains, chronic cough, urinary complaints and other common health issues often are either overlooked by Western physicians or inadequately treated.  TCM treatments of acupuncture, moxibustion, cupping and herbal therapies may offer an effective alternative to pharmaceuticals and surgery with less risk and fewer side effects.  I have seen benefit from these “manipulations of Qi” and believe that as the Western public becomes more aware of TCM it will become a commonplace mode of therapy.

Perhaps, even more exciting to me is the use of TCM as an adjuvant to Western Medicine.  We know that sophisticated Western laboratory and diagnostic testing is very effective in establishing Western diagnoses that are amenable to pharmaceutical and surgical therapeutics.  TCM, used as an adjuvant to these treatments offers a unique opportunityto improve the constitution of individuals thereby increasing their natural abilityto fight disease.  Also, by working through a different pathway TCM holds promise to increase the effectiveness of the Western Medicine treatment. 

This is the reason TCM/acupuncture combined with Western Medicine provided by high quality IVF centers offers patients their optimal chance for pregnancy success. 

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Have you, or has anyone you know, used TCM/acupuncture as an adjuvant to IVF or another assisted reproductive technology? Did you feel it made a difference?




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Infertility and TCM (Part 7): The Doctor as the Acupuncture Patient

By David Kreiner MD

April 27th, 2014 at 11:35 pm

 

credit: stuart miles/freedigitalphotos.net

In case it has not been clear up until now, I have my doubts about the scientific explanations regarding acupuncture.

Perhaps, it is too much to ask a 58 year old Western-trained physician to believe in something he cannot see, feel or measure. However, being a younger member of the baby boomer generation I now have my own set of common physical complaints ranging from arthritic joint pains to urinary changes to sleep issues, and more. Therefore, I thought it would be at least interesting if not helpful to go for an acupuncture exam and treatment.

Of course, I was not a typical acupuncture patient since I am a physician who does not entirely accept acupuncture as an effective alternative form of traditional health care. You might say that I am an open-minded skeptic with some very typical complaints for a man my age.

As instructed, I arrived early at the Acupuncture clinic in my school in order to fill out the questionnaire, a routine in most doctors’ offices including my own.  After completing the extensive questionnaire (which made me feel as if I were writing my memoirs) I was called in and brought to a room with a fairly comfortable-looking stretcher/bed. I gowned and for the next 20 minutes answered the acupuncturist’s questions about my complaints, my dietary and bowel habits, exercise routine and more. There were some unusual questions like what foods do I yearn for, do I have bad breath or odors, do I dream, etc.

Then the examination began. I extended both arms over a pillow to have both radial pulses palpated in three positions from just proximal to the wrist crease to about two inches up going towards the elbow crease. Much focus and time was spent on this. After the acupuncturist completed his study of my pulses, he began a very thorough inspection of my tongue along its entire length and on both sides.  Being quite curious about the acupuncturist’s findings I asked him about what he learned about me from the examination.  

Based on my pulse, I showed evidence of weakness in the liver and heart but it was suggested that my beta blocker that I take may account for this. My tongue showed evidence of dampness, one of the Traditional Chinese Medicine pathogens in the body.  The acupuncturist said that based on my history and examination that I exhibited a Kidney Qi or yang deficiency with dampness and that I also suffered from cold, another pathogen.

The acupuncture prescription was aimed at tonifying Qi and yang as well as tonifying kidney and spleen which can cause the dampness.  He was also going to needle points specifically aimed at removing the dampness.  In addition he was going to needle points to calm my “shen” to aid me in my ability to sleep uninterrupted.  He said tonifying the kidney, in addition to needling some bladder points, may help with the urinary problems.  There are specific acupoints for treating all issues and complaints.  The joint pain in my thumb he would address as well.

 

I was anxious and excited to get started.  After all it isn’t every day that you ask someone to stick needles into your body.  

The first needle was inserted perpendicular to my skin about half way up my left leg.  The needle was so thin that it did not hurt as he tapped it through my skin however when he twisted the needle in deeper it caused a very mild “electric-like” shock. It wasn’t that it was painful but it was not a sensation that I am used to feeling. However, the next point he inserted a needle into in the right leg caused an even bigger shock that made my left leg jump a bit which is where I felt the shock.  A few needles later, at a point in the crook of my left arm upon insertion of the needle I felt a shock immediately in my left leg causing it to jump again.  

As I lay on the stretcher I was thinking, “What kind of magic is this that needles inserted on the right side can affect the left and on an upper limb can impact on a lower limb?”. When a needle inserted at the base of my right thumb caused a shock shooting to the tip of my finger I figured that it was a routine reaction when one moves Qi. I lay in the bed with the lights off for about 20-30 minutes very relaxed but a little disappointed when the acupuncturist returned to interrupt my rest and remove the needles.

I had class that evening and was in a great mood. In fact, one of the students asked why I looked so spiffy. It was not the way I was dressed. The next day, I felt great and was in a very good mood again. I cannot say whether I have no more dampness but the cough which plagued me my whole life was gone and that is even while having an upper respiratory infection.

I can say that today,  as a result of my experience with this acupuncture treatment, I am a little less skeptical that there are pathways of Qi in the body that may be manipulated to improve one’s health and well-being.

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Does this experience make you more or less likely to try acupuncture? Why?

 

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Infertility and TCM (Part 5) Channels and Points: TCM’s Gross Anatomy Equivalent

By David Kreiner MD

March 31st, 2014 at 2:05 pm

 

image courtesy of stuart miles/freedigital photos.net

 

As a new student in Traditional Chinese Medicine (TCM) and acupuncture one of the first and most important classes we must take is called “Channels and Points”. This to a former medical student is the TCM version of Gross Anatomy. Gross anatomy in medical school was my exciting introduction to the human body, essential to the study of medicine.  I owned the classic Gray’s Anatomy text which today is popularized by the TV show of the same name.  The course requires strict memorization of all the bones, nerves, ligaments, vessels and organs in the body.

Likewise, “Channels and Points” requires the memorization of the precise location of 365 points and the corresponding channels of Qi which course throughout the body and can be utilized in the practice of acupuncture.  How these channels and points relate to each other and to the different organs is important as that will also determine their usefulness in different clinical situations.  

It is believed that the location of the channels of Qi and their surface access points was discovered through centuries of observation of the existence of tender spots on the body during the course of disease.  Furthermore, it was observed that symptoms were alleviated when those points were stimulated by massage or heat.  

When a number of points became known, they were linked into groups with common characteristics and effects and hence a pathway for a channel was identified.  Knowledge accumulated over hundreds of generations documented in several ancient texts.  As information regarding the channels and points accumulated, theories evolved and often resulted in modifications of prior beliefs as more experience clarified more accurate placement and function of these channels and points.  

The first document that unequivocally described the channels and points in an organized system of diagnosis and treatment recognizable as acupuncture is The Yellow Emperor’s Inner Classic, dating from about 100 BCE. The information was presented in the form of questions posed by the Emperor, Huang Ti, and replies from his minister, Ch’i-Pai. The source of the text of his answers was likely a compilation of traditions handed down over centuries, presented in terms of the prevailing Taoist philosophy, and is still cited today in support of particular therapeutic techniques. There is evidence that acupuncture utilizing bronze, gold and silver needles was practiced around this time as well as moxibustion.  

A more contemporary view of the concepts of channels in which Qi flowed that was documented through the precise anatomical locations of acupuncture points developed later.  During the Ming Dynasty (1368–1644), The Great Compendium of Acupuncture and Moxibustion was published, which forms the basis of modern acupuncture. It includes descriptions of the full set of 365 points that represent superficial access to the channels through which needles could be inserted to modify the flow of Qi energy.

Unlike the bones, tendons, nerves and vessels of Gross Anatomy, the channels and points utilized in acupuncture do not have corresponding visible or palpable anatomic structures that may be identified in an effort to memorize.  These channels of Qi are not visible structures nor can they be felt through touching or palpation.  So how does the acupuncturist know where the surface access point is to direct his needle?  

The trained acupuncturist utilizes the surface anatomy such as bones, joints and ligaments to locate these acupoints.  The points typically are found between the ligaments, in bony crevices or between bones. Additionally, the body is divided into units of measure based on an individual’s own bone size.  The most basic unit, cun, is defined as the width of the individual patient’s thumb.  Two cun is the distance from second most distal or middle joint of the forefinger to the tip.  Three cun is the width of the forefinger to the pinky measured at the point of the middle joint of the fingers.  The arms are 9 cun from axilla to the transverse crease of the elbow and 12 cun from the elbow crease to the wrist crease.  The number of cun for every portion of the body is delineated so that the location of the acupoints is based on locating according to the distance by cun units from an identifiable spot on the surface anatomy of the patient and usually are found in between ligaments, bones or in the bony crevices which are palpated by the acupuncturist upon needle placement.  

There are also some points that are identifiable based on particular placement of the fingers and hands of either or both the acupuncturist and patient.  For example, if the acupuncturist places his finger on a patient’s styloid process then has the patient internally rotate his/her hand, the point is located where the acupuncturist’s finger ends up.  This point, currently my favorite, is Small Intestine (SI) 6 with the English name of Support for the Aged because it treats symptoms such as blurry vision, lumbar pain, neck pain and other aches and pains that affect individuals as they get older.  

Another critically important point and therefore given the distinction of being a Command Point for the head and nape of the neck is Large Intestine (LI) 7.  It is located when the acupuncturist places his/her index finger on the dorsal side of the patient’s hand and thumb on the ventral side in between the patient’s thumb and forefinger.  The acupuncturist will locate the point where the tip of his forefinger meets a groove in the anterior portion of the patient’s radius bone.  

How deep to place the needle and in what direction and angle are further issues to be learned another day.

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Are you finding this educational journey into TCM fascinating? Do you have any questions for Dr. Kreiner about this or any other TCM topic he has covered so far?

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TCM and Fertility: The Importance of Vital Substances and Maintaining Balance

By David Kreiner MD

March 20th, 2014 at 2:07 pm

 

image courtesy of stuart miles/free digital photos.net


Traditional Chinese Medicine (TCM) has presented such a challenge to my Western scientific perspective that I neglected to define the basic principles on which TCM is based. 

 

TCM, and life itself, according to Chinese tradition which developed over the past three thousand years starts with the vital substances, Qi and Essence, in addition to blood and body fluids.  Our human physiological functioning is dependent on these vital substances which the body attempts to maintain in balance between Yin and Yang.  The Qi and Essence, blood and body fluids will interact and perform their essential roles throughout the body dependent on the Zang-Fu and “extraordinary” organs and the states of Yin and Yang while traveling through vessels, channels, and branches that interconnect with each other.

The concept of Qi comes from the Chinese Taoist philosophy that has been described as a “life force” but is actually an aggregate of ideas that we Western thinkers like to separate to better understand.  To our way of thinking it likely is a form of energy, or electric potential that crosses cell membranes as it traverses from one part of the body to another.  Chinese tradition identifies many different forms of Qi each with different functions affecting physiology and life.  The acupuncturist studies the channels through which Qi flows in the body to modify its flow for a particular purpose… whether to eliminate pain or improve an individual’s health, both of which may be impacted by some pathology of Qi level or flow.

Essence (Jing) is considered one of the three treasures of TCM, along with Qi and Shen (spirit).  Jing is stored in the kidneys according to TCM and nourishes and fuels the body.  There is Prenatal Essence which is supposedly inherited much like DNA and cannot be renewed.  It is responsible for an individual’s constitution and congenital illness. Postnatal Essence can be replenished by food, herbs, acupuncture, or exercise such as T’ai Chi.  Total Essence is made up of both Prenatal and Postnatal Essence and is responsible for growth, development, and reproduction.  Effects of aging may be caused by a deficiency or deterioration of one’s Essence.

In Chinese philosophy, the concept of Yin and Yang is used to describe opposite yet complementary forces that are both interdependent and interconnected and give rise to each other.  Yin and Yang interact in a dynamic way.  Whenever one quality reaches its peak, it will naturally transform into the other.  In TCM, good health is directly related to the balance between Yin and Yang qualities within oneself. If Yin and Yang become unbalanced, one of the qualities is considered be either deficient or in excess… which can lead to illness and disease.

The traditional Chinese concept of human organs, known as Zang-Fu and “extraordinary organs”, are not primarily based on anatomical considerations.  They instead are defined as functional entities with a general location in the upper, middle, or lower Jiao separated by the diaphragm and the umbilicus.  The three Jiao (San Jiao) together is considered a functional organ in TCM and… in addition to separating the other organs into three cavities including chest, upper abdomen and lower abdomen… it functions in the transport of Qi and body fluids.  These Zang-Fu and additional “extraordinary” organs are interconnected with each other through channels of Qi in addition to vessels containing blood and body fluids.  As a result, a problem in one organ can affect the functioning of another.

TCM differs from Western Medicine mostly in its holistic approach as compared to our Western reductionist way of scientific thinking.  Disease and illness according to TCM is a result of a disharmony in the functions of Yin and Yang, Qi and its pathways or meridians, the organs (Zang-Fu and “extraordinary”), Essence, and/or the interaction between the individual and his/her environment.  Therapy is based on which disharmony pattern is identified and may include behavioral modifications including diet and exercise, treatments including herbs, acupuncture, and moxibustion, as well as other interventions.

 

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What TCM concept explained above is most fascinating to you? Which would you like to learn more about?

 

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Acupuncture: What’s the Point?

By David Kreiner MD

March 12th, 2014 at 3:29 am

 

image courtesy of stuartmiles/freedigitalphotos.net

I have previously mentioned the conundrum facing a Western-trained physician embarking on the study of Traditional Chinese Medicine (TCM).  It is part of our nature after a lifetime of scientific training to explain natural phenomena such as health and illness in ways that have been documented with physical evidence. 

The basic physiology on which TCM is constructed has no corresponding physical support that can be seen or measured…a requirement that scientific thinkers rely on to reassure ourselves about the validity and rationale of a proposed theory or treatment.

Instead, it feels to me as I study TCM that I am memorizing random “facts” with corresponding syndromes and treatments.  For now, I must push myself to continue my studies unconcerned that these basics I am committing to memory are not supported by any physical evidence other than the stories of successful therapies.  It is premature for me to pass judgment for as they say, “the proof is in the pudding”. 

In fact, as a practicing reproductive endocrinologist I have seen patients with poor ovarian function or previous failed pregnancies succeed in their child-building endeavors after acupuncture intervention is added as an adjunct to their fertility treatments. 

For this reason, I persevere to learn as much as possible because despite my own admission that TCM is difficult for me to accept as “scientific truths” I believe that it offers potential advantage to my patients as they go through their Western fertility therapies.

* * * * * * * ** * *** * * * * * * * * * * * ** *

How important to you is the science…or measurable physical evidence…behind an infertility therapy? Can you take a leap of faith and hope “the proof is in the pudding”?

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Acupuncture: What’s the Point?

By David Kreiner MD

March 11th, 2014 at 8:22 pm

 

image courtesy of stuart miles/free digital photos.net

I have previously mentioned the conundrum facing a Western-trained physician embarking on the study of Traditional Chinese Medicine (TCM).  It is part of our nature after a lifetime of scientific training to explain natural phenomena such as health and illness in ways that have been documented with physical evidence. 

The basic physiology on which TCM is constructed has no corresponding physical support that can be seen or measured…a requirement that scientific thinkers rely on to reassure ourselves about the validity and rationale of a proposed theory or treatment.

Instead, it feels to me as I study TCM that I am memorizing random “facts” with corresponding syndromes and treatments.  For now, I must push myself to continue my studies unconcerned that these basics I am committing to memory are not supported by any physical evidence other than the stories of successful therapies.  It is premature for me to pass judgment for as they say, “the proof is in the pudding”. 

In fact, as a practicing reproductive endocrinologist I have seen patients with poor ovarian function or previous failed pregnancies succeed in their child-building endeavors after acupuncture intervention is added as an adjunct to their fertility treatments. 

For this reason, I persevere to learn as much as possible because despite my own admission that TCM is difficult for me to accept as “scientific truths” I believe that it offers potential advantage to my patients as they go through their Western fertility therapies.

* * * * * * * ** * *** * * * * * * * * * * * ** *

How important to you is the science…or measurable physical evidence…behind an infertility therapy? Can you take a leap of faith and hope “the proof is in the pudding”?

no comments


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