Image by Thomas van de Weerd [flickr/thms]. Edited. License https://creativecommons.org/licenses/by/2.0/

There are bright sides to COVID-19. One benefit is that it allows more time for self-improvement. The load it places upon our backs is like a stone to hone our grit. As it grinds us to the core of our nature, it also forces us to rethink how we get things done.

While the economic shutdown renders us less productive, it ironically creates an opportunity for enhanced efficiency. We can now better understand the value of our time. Without the blood-sucking commutes, traffic jams and rush hours, there is less to distract us from what matters most.

One of the things that truly matters—and is entwined with everything else in our life—is our health. To help you focus on the matter, I will always enjoy the presence and face-to-face interaction that acupuncture requires. But what the recent social distancing and sheltering has helped me realize is that there are tolerances in a health plan for continuity of treatment without extra time spent in the clinic.

In that vein, I am now offering telehealth services. This will not only help you comply with current social distancing and sheltering requirements, but may also offer better logistics and more time to focus on the other things that matter once the pandemic ends.

The time saved by telehealth is ideal for:

• • Acupuncture consults
  • Wellness consults
  • Integrative health plan reviews
  • Chinese herbal prescriptions

After scheduling an appointment, please visit my telehealth waiting room.

I look forward to seeing you soon.

Image by Karen Eliot [flickr/kareneliot]. License https://creativecommons.org/licenses/by-sa/2.0/

Much to unpackage / Covid truth is hard to find / A novel vector

#haiku

Here is a fascinating podcast interview by the Weston A. Price Foundation, featuring Dr. Tom Cowan. It’s relevant not only to the COVID-19 pandemic but also to the nature of viruses and epidemics, in general.

There is definitely a lot to unpackage and process; and I share this not as an endorsement, but rather to help keep minds open. Whatever controversy Dr. Cowan’s informed perspective may stir, it at least highlights that there are unknowns in medicine.

He sheds light on the assumptions about COVID-19, and presents the possibility that it may not be infectious after all. Whoa! Full stop.

Have a listen. You’ve got time.

Heads up: There are a lot of disclaimers that preface the interview. I think it portrays the doctor’s frustration with the contention he encounters. Afterwards, it gets very interesting; he presents his views logically, with a clear line of thought.

‘Stress,’ by Bernard Goldbach [flickr/topgold]. License https://creativecommons.org/licenses/by/2.0/

My optimism was originally bolstered by the statistics coming from China via the World Health Organization and their daily Situation Reports. But looking at current stats and the behavior of SARS-CoV-2 outside of China, the WHO numbers—in my view—clearly do not add up.

Further, there are allegations of negligence pointed at the WHO director-general, Tedros Adhanom Ghebreyesus, related to biased reporting in favor of China; add to that, the WHO’s reluctance to declare a pandemic. While it’s hard to separate politics from public health policy, the math is revealing.

The reality of COVID-19 requires us to adapt to new and more accurate data coming from the CDC. SARS-CoV-2 appears much more virulent than expected if one were to model off of the WHO’s accounting in China. While I believe that temporarily shutting down a large portion of our economy is a prudent adaptive response to this coronavirus, it does present a new epidemic of fear as our livelihoods diminish.

This fear can not only impact mental and physical health but also lead to further economic depression. So it would benefit us all if we could control this fear by adapting to the current stress.

The Stress Response

The stress response is a mechanism of self-preservation. It helps us “get off the X” whenever there’s danger. But under prolonged hardship, the stress response becomes counterproductive as it diminishes our ability to maintain health, suppresses immunity, and clouds strategic planning.

You can quickly turn off the stress response (fight-or-flight mechanism) through quiet breathing. This is not about silence, but rather a contrast to forced breathing.

Quiet Breathing vs. Forced Breathing

Quiet breathing occurs when you rely mostly on the diaphragm muscle. It is the platform beneath the lungs that contracts to allow lung expansion. After that, minimal energy is required. Air naturally flows in to fill the increased lung volume. No muscle contraction is required for exhalation; simply relax, and the elasticity of the diaphragm and lungs will push air out.

Forced breathing occurs during exertion and often during times of stress. Accessory muscles in the neck and torso are recruited to expand the rib cage and increase lung volume as much as possible. This allows in more oxygen so the body can do more work, but also produces more carbon dioxide. So in contrast to quiet breathing, this requires contraction of accessory muscles (including the abdomen) to forcefully excrete excess CO₂.

Forced breathing is part of the stress response, as it fuels the energy required to get off the X. It also occurs during chronic stress where the survival instinct is set to full-auto. The adverse effects of chronic stress are worsened by the inefficiency of forced breathing during this time: the accessory muscles trying to force air into the lungs are working against a usually tense abdomen that is placing upward pressure on the lungs.

It takes self-awareness to switch back to quiet breathing when stress becomes chronic. Doing so will allow revitalization, normal immune response, and clear thinking.

Because the context of the present pandemic will vary depending on your personal situation, there is no one solution for navigating this challenge.  But the clear thinking afforded by quiet breathing will help you find a way.

Mastering the Quiet Breath

Master your breath by straightening your posture and inhaling through your nostrils. The restricted airflow (compared to mouth-breathing) will help regulate your pace so you can achieve a calm inhalation lasting 5-7 seconds.

Nasal breathing also warms the air as it passes through the turbinates. The increased temperature increases the air pressure to further expand the lungs without the use of accessory muscles.

Relax your abdomen to allow your lungs to fully expand. When done properly, you may get a sense of the diaphragm beneath your lungs. This is the muscle that contracts to draw in air.

You may exhale either through your mouth or nose since there is no need to regulate airflow during this phase. There is no need to time the exhale, either. Just focus on relaxation and let the pressure in your lungs escape naturally. This is done by relaxing the diaphragm, not by pushing the air out. (Forcing air out through muscle contraction can simulate stress and adrenalize the body.)

Rinse (carbon dioxide) and repeat.

Image: Chris Potako (flickr/chrispotako), CC BY 2.0

The past couple of weeks haven’t quite been a vacation. I suspect most of us are anxious to get back to work. As we “non-essentials” alternate between quasi-homesteading and daily constitutionals, many of us may be filling the time gaps with DIY projects; or at least, looking for something to do.

Here’s a project: foot bath.

A foot bath doesn’t sound like your typical DIY activity. However, for a western culture not generally accustomed to herbal self-care, this can very well turn into a big task.

China loves foot baths. At least, compared to anyone I know. In China—and in Chinese medicine therapies around the world—herbs are often added to foot baths, depending on the therapeutic goal.

The following foot bath is a recent recommendation in China for home care and prevention of COVID-19. The recipe includes several herbs commonly used in Chinese medicine for infectious or inflammatory diseases.

Not all herbs are required. But the more you include, the broader the therapeutic spectrum. While a few of the herbs are common, most will likely be unfamiliar to you. This is where the DIY-sense starts to seep in—as you learn about and collect these herbs.

The herb collecting may be challenging. But you might be fortunate to have a local Chinese herbal pharmacy—that remains open. If so, I’ve included the Chinese (pinyin) names to aid your herb run.

Foot Bath Recipe

15 grams each:

• Nepeta (jing jie)
• Wormwood (qing hao)
• Mint (bo he)
• Houttuynia (yu xing cao)
• Woad leaf (da qing ye)
• Eupatorium fortune (pei lan)
• Acorus tatarinowii (shi chang pu)
• Polygonum flaccidum (la liao; la ma liao; or liao zi cao)
• Turmeric root (yu jin)
• Clove (ding xiang)

Plus, 3 grams of borneol [Important for aiding absorption of herbal compounds through the skin.]

Source: World Federation of Acupuncture and Moxibustion Societies (WFAS), Beijing, China.

The herbs are prepared by decoction; by combining all ingredients, adding water, and bringing to a boil before simmering for about 20 minutes. Then strain the herbs.

The decoction is generally cooled to 100-110 °F to allow foot soaking for 30 minutes. Pour the decoction into a foot basin and top it off with warm water until feet are submerged.

You can increase the dosages proportionately to make a larger batch to be stored in the fridge. Just reheat or add warm water to the foot basin for each soak. Do not re-use a decoction that has already been soaked in. Scientifically, because that’s gross.

Image by Dennis Jarvis (flickr/archer10), CC BY-SA 2.0

SARS-CoV-2 is an intrepid world traveler, but not an easy rider. And—politics notwithstanding—I believe the medical, scientific and governmental institutions are doing all they can to contain it. It’s challenging because the virus moves so efficiently; while effectively analyzing a new scenario typically requires time to build data.

We’ve seen a commendable concerted effort to meet this challenge. As evidence, I’m pleased that a scientific review of herbal compounds relating to possible anti-SARS-CoV-2 activity has been published in a short timeframe (Zhang, 2020); and it appears thorough. Even so—hygiene, etiquette, social distance, and quarantine will be the most effective means of viral infection control.

From experiences with SARS (2002/3) and MERS (2012), 115 naturally occurring compounds have been identified as showing anti-coronavirus activity. Based on the compounds’ digestive absorption, distribution within the body, metabolism, and elimination, the list was pared down to 13 candidates.

These candidates relate to individual compounds only. To identify Chinese herbs that might address SARS-CoV-2, they had to contain at least 2 of the compounds and to have been historically used to treat viral respiratory infections.

According to the referenced research, there are 26 plants that may help fend off SARS-CoV-2. Depending on their action, they may be used to either treat COVID-19 or prevent infection. These herbs are listed below with suggested time of use, i.e. during stages of prevention, early onset or suspected exposure, or infection.

For prevention

• • Fortunes bossfern rhizome

For early onset, or suspected exposure

• • Tamaricis cacumen*
  • Erigeron breviscapus
  • Bupleurum root

For infection, depending on symptoms

• • Forsythia fruit
  • Licorice root
  • Mulberry root bark
  • Chrysanthemum flower
  • Tussilage flower
  • Honeysuckle flower
  • White mulberry leaf
  • Hogfennel root
  • Wild buckwheat rhizome*
  • Coptis rhizome
  • Houttuynia
  • Hovenia seed
  • Inula flower
  • Loquat leaf
  • Astragalus root
  • Lepidium seed
  • Marlberry*
  • Aster root
  • Sun spurge*
  • Ginkgo nut
  • Anemarrhena rhizome
  • Epimedium herb

The herbs marked with (*) are not readily available in the U.S. So they would need to be analyzed for accessible substitutes.

There’s a but…

Now, I like identifying options. So I find the above list valuable because it expands the clinical repertoire. However, for mild COVID-19 cases, I believe the simplicity of rest and nourishment (as outlined here) should be sufficient. For severe cases, I would rather you go to the hospital for biomedical support. Pneumonia is life-threatening to the vulnerable population segment, where the severe cases are prevalent.

That being said, you have voting rights on the determination of your healthcare. So if you’d like to talk about the herbal options above, please feel free to contact me.

Interestingly, woad root (which I discussed here) was not included by the study referenced in this post.

Reference

Zhang DH, Wu KL, Zhang X, Deng SQ, Peng B. In silico screening of Chinese herbal medicines with the potential to directly inhibit 2019 novel coronavirus. J Integr Med. 2020; 18(2): 152-158.

Image by flickr/vgm8383, CC BY-NC 2.0

Acupuncture is generally painless. It even has a calming effect and increases a sense of well-being, partly by releasing endorphins. However, a patient who is normally not sensitive to needle insertion may occasionally feel a slight prick. While the experience doesn’t reduce the overall treatment comfort, it does often cause wonderment as to why it occurs.

This doesn’t apply to pain due to poor needling technique from either inexperience or distraction; or to apprehension that may result in hypersensitivity. Rather, these are my thoughts on what is happening during the random instances of needle sensitivity.

The skin is our first line of defense against external threats. Its dermal layer is made of dense irregular connective tissue, mimicking a woven fabric that absorbs forces from a multitude of directions. This ensures our skin doesn’t tear from the slightest impact.

Acupuncture needles are finely honed, with a diameter that is often less than or equal to that of head hair. So its profile isn’t a threat, and the connective tissue normally separates to accommodate needle insertion.

Sometimes the angle of insertion may allow the needle to catch on the tissue fabric, triggering a nerve signal and pricking sensation. Not a big deal. We can normally disregard the sensation because it’s so fleeting, or adjust the needle angle to prevent irritation.

Dehydration can also play a role by causing irritability of the sensory nerves; or increasing the friction between tissue fibers, elevating puncture resistance. While we can’t stop a bullet with our skin, we can hinder artful needling technique. So, as always, stay hydrated.

Image by Kilworth Simmonds [flickr/davidwithacamera], CC BY-SA 2.0

At that time, 99% of COVID-19 cases were isolated to China. But for the first time, around Feb 26, there were more new cases outside of China than within. As of Mar 9, China now represents 73.8% of global confirmed cases. There are now confirmed cases in 104 countries, and COVID-19 appears—in some cases—to be spreading by community infection (i.e. no clear source of infection).

COVID-19’s global presence and apparently increased transmission efficiency is technically a pandemic. But the World Health Organization is reserving that term for later use, probably in an effort to prevent panic. While COVID-19 is pandemic, I believe there is optimism in this shifting tide…

The number of COVID-19 cases in China is declining. Mainly, this may be attributed to the widespread quarantine measures taken, but also to the possibility that the infections have peaked. So, within a couple months, ground-zero China has been able to get a good handle on this novel virus.

This is optimistic for us because we have the benefit of China’s experience and the capability to compress their timeframe in resolving the caseload.

As the world watched China grapple with COVID-19, we’ve had time to prepare. We’ve increased our awareness of the risks of community transmission; our healthcare system has been anticipating increased cases as a natural progression of a novel infectious disease; and we obtained the DNA of SARS-CoV-2, early on, to get started on a vaccine.*

[Update, 3/14/20: A good friend corrected me on the “DNA of SARS-Cov-2” as follows…

The virus doesn’t contain DNA, only viral RNA. This is why it’s been challenging to perform the tests, RNA degrades easily and special reagents are required to prevent exposure to RNAase enzymes found abundantly on our skin etc…

RNA has to be stabilized and protected so it can undergo PCR to form cDNA (antisense RNA)–not naturally occurring–which is more stable; and this is what is sequenced to determine if a person is infected with COVID-19.

Much appreciated, S.G.]

While there has been a delay in the availability of COVID-19 testing kits, we still have the benefit of prior knowledge. We know the symptoms, the severity and the risks. The risk of community transmission is still relatively low, and we can mitigate that risk further by sticking to standard precautions.

Also at the time of my previous post, the fatality rate was 3%. This is relatively unchanged. As of Mar 9, the global fatality rate is 3.5%. Outside of China, it is 2.4%. The fatality rate is greater in China, as they were ground zero, with no advance measures in place.

The last statistic we looked at was the basic reproduction number, R₀. It is the average number of people that a contagious person can be expected to infect. In my last post, R₀ ranged from 1.4-5.5. This range is fairly broad due to a discrepancy between sources. Currently, R₀ remains within that range. The median is 2.79. Since this number has always been above 1.0, statistically it is no surprise that COVID-19 continues to spread. “Spread” does not mean unmanageable.

So now that it’s here, what do we do? We recognize that we are not defenseless…

Supportive Care

If you suspect you may have COVID-19 and your symptoms are not severe, then try to self-quarantine and not overload healthcare facilities so they can accommodate more severe cases. In self-quarantine, follow supportive care by focusing on rest and nourishment. Protein and fluids are required.

Think: chicken soup, or porridge (with chicken or egg). With added herbs:

• • Astragalus root for immune system support
  • Ginger and licorice root for cough

If you have a high fever, and a lancet (30 gauge or above), lightly prick the apex of either ear to quickly lower the fever.** Find the apex by folding your ear forward to the side of your face; the apex is located at the kink on top of your ear. If you have a mild fever, let it run its course and focus on water intake. (Fever is part of our defense mechanism against pathogens.)

While the U.S. healthcare system gets a poor grade in managing chronic disease, I believe this is the place to be for the treatment of severe infectious disease. We have the facilities, innovation and expertise. So, if you have severe symptoms, do not hesitate to tap into our healthcare system.

After 14 days of being symptom-free, seek acupuncture to revitalize your health and tone your immune system.

And if you’re looking for hand sanitizer, wait a couple months. Soon they’ll be sold for dimes on a street corner near you, as hoarders dump their supplies.

Notes

*A vaccine is a long-term solution. It can take 1.5-2 years, at best, to go from drug discovery to broad market availability.

**Pricking the ear with a safety lancet is simple and painless, but technique matters. If you’re uncomfortable with your technique, then seek a professional to perform the procedure. I am not responsible for your technique.

Image by Jay Javier (flickr/cooey), CC BY-NC-ND 2.0

The latest coronavirus, which was officially declared this past New Year’s eve, is actually the third one of its kind. The first coronavirus was the severe acute respiratory syndrome (SARS) outbreak in 2002; the second, the Middle East respiratory syndrome (MERS) in 2012. While coronaviruses are responsible for the majority of common colds, these three are distinct because they were transmitted to us from another species.

This outbreak is suspected of originating in bats and was first labelled 2019-nCoV—short for novel coronavirus (novel, because it’s a new strain never before seen in humans). The World Health Organization (WHO) has updated the name to COVID-19. [Here, I’ll use the names interchangeably, either based on the source or for prosaic flow.]

Because this is a new virus, we lack historical data. So any conclusions drawn from what we do know seem to evolve in real-time; and the statistics discussed here may soon be revised. However, let’s get some perspective on current statistics.

99%

Ninety-nine percent of global laboratory-confirmed cases have occurred in China, based on WHO Situation Report-27 dated 2/16/20.

All other cases seem to have been exported from China. So, travel within China or contact with someone who has traveled within China is the biggest risk factor. While “contact” is a loose term, based on six degrees of separation, at least all the U.S. cases tested by the CDC seem to fit the risk profile. Specifically, 5% of the U.S. cases were found to be positive for COVID-19.

[Update, 2/18/20: According to the WHO Situation Reports, there was an almost 38% jump in global cases from 2/16/20 to 2/17/20. The large increase is attributed to a less restrictive inclusion criteria that now adds clinically diagnosed cases rather than just the laboratory-confirmed. Therefore, the new numbers are more conservative. The 99% statistic remains valid.]

3%

The fatality rate for 2019-nCoV is 3%.

This rate is less than that of the other coronavirus outbreaks. SARS and MERS had death rates of 10% and 40%, respectively; and those outbreaks barely put a dent in our memory. This too will pass. But to be fair, as the world actively responds to the ongoing outbreak, that rate can change by significant degrees.

1.4-5.5

Another value to look at is the basic reproduction number, R₀ (“R naught”). This is the average number of people that a contagious person can be expected to infect. For 2019-nCoV, R₀ ranges from 1.4-5.5. Generally, an R₀ >  1 increases the risk of an epidemic. But to put it into perspective, the MERS R₀—that had a death rate of 40%—was less than 1.

SARS had a similar R₀ range of 2-5.

SARS 2.0

COVID-19 is similar to SARS in that they invade our cells via the same receptor protein, ACE2. So, the current assumption is that they will behave the same. This assumption is supported by their similar R₀ values.

Based on the pathogenetic similarities between COVID-19 and SARS, there is speculation that we may benefit from SARS prevention measures.

During the SARS outbreak in 2002/03, Traditional Chinese Medicine hospitals in China were using woad root (Isatis indigotica) for the treatment or prevention of SARS. The clinical basis was that woad root is a well-established anti-viral in Chinese medicine. However, it is important to note that the resolution of SARS should be mostly attributed to the quarantine measures taken and not to some superherb.

While woad root has historically been a strong and effective anti-viral, novel virus strains present new ball games; especially viruses that adapt and evolve quickly like SARS did, and possibly COVID-19. That’s not to say it isn’t worth putting woad root to the test, but that the primary focus should be on standard prevention, monitoring yourself and others, testing suspected infections, and quarantining confirmed cases.

Standard Prevention:

• • Wash hands frequently
  • Avoid touching eyes, nose, mouth
  • Covering mouth if coughing or sneezing
  • Trying to stay at least 3 feet away from known cases of infection [Update, 3/17/20: prior to COVID-19, and at the original time of this post, the consensus standard for social distancing was 3 ft. The recommended distance has since been extended to 6 ft.]

After the primary focus has been met, woad root is definitely a candidate for an added layer of defense, or as an integrative treatment. It has a long history of use in Chinese medicine for viral infections.

Scientifically, the major chemicals in woad root are phenylpropanoids, alkaloids and organic acids. The most active ingredients appear to be clemastanin B (CB) and epigoitrin. While none of the compounds or individual chemicals have been shown to kill a virus directly (in vitro), they do inhibit virus multiplication and attachment.

Viruses cannot survive on their own. They need to attach to our cells before invading them, then splice into our DNA * after entering. After reprogramming our “software,” * they can replicate and build an army to seek and destroy more of our cells.

[* Correction, 2/18/20:

Coronaviruses are RNA viruses and do not enter the nucleus of the cell where our DNA resides. They use the components within the cytosol to replicate. For viruses that do enter the nucleus, alteration of our DNA is an infrequent event.]

Woad root works by first building a firewall at the cellular level, preventing virus attachment. The second layer of defense is to disrupt a virus’ ability to replicate. The cells that are infected would experience a natural cell death (senescence) and be cleared by our immune system.

References

Bajema, Kristina L, et al. “Persons Evaluated for 2019 Novel Coronavirus – United States 2020.” Centers for Disease Control and Prevention, 14 Feb. 2020, www.cdc.gov/mmwr/volumes/69/wr/mm6906e1.htm?s_cid=mm6906e1_w.

Battegay, Manuel, et al. “2019-Novel Coronavirus (2019-NCoV): Estimating the Case Fatality Rate – a Word of Caution.” Swiss Medical Weekly, 2020, doi:10.4414/smw.2020.20203.

Chen, Jieliang. “Pathogenicity and Transmissibililty of 2019-NCoV–A Quick Overview and Comparison with Other Emerging Viruses.” Microbes and Infection, 4 Feb. 2020, doi:10.1016/j.micinf.2020.01.004.

“Coronavirus Disease 2019 (COVID-19), Situation Report – 27.” World Health Organization, 16 Feb. 2020, www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports/.

“Coronavirus Disease 2019 (COVID-19), Situation Report – 28.” World Health Organization, 17 Feb. 2020, www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports/.

Fehr, Anthony R., and Stanley Perlman. “Coronaviruses: An Overview of Their Replication and Pathogenesis.” Coronaviruses Methods in Molecular Biology, 2015, pp. 1–23., doi:10.1007/978-1-4939-2438-7_1.

NIH, National Institute of General Medical Sciences (NIGMS). “Our Complicated Relationship with Viruses.” ScienceDaily, 28 Nov. 2016, www.sciencedaily.com/releases/2016/11/161128151050.htm.

Su, Jia-Hang, et al. “Modes of Antiviral Action of Chemical Portions and Constituents from Woad Root Extract against Influenza Virus A FM1.” Evidence-Based Complementary and Alternative Medicine, vol. 2016, 2016, pp. 1–8., doi:10.1155/2016/2537294.

Image by LongitudeLatitude (flickr/longitudelatitude), CC BY 2.0

In my previous post, I explained how acupuncture creates piezoelectricity to open the ion channels of our cells. Here we’ll discuss acupuncture’s effect on opioid and cannabinoid receptors. But first, let’s talk about the general research environment in acupuncture. (Or, you can skip to the –oids section below.)

Much of the latest research evaluates electro-acupuncture, as opposed to manual acupuncture (i.e. without electrical stimulation). This does not necessarily mean that electro-acupuncture is more effective, for there may be a number of reasons why electro-acupuncture studies dominate.

Manual acupuncture has been performed for at least 2,000 years. Throughout that span, there have been a few innovations; for example, upgrading the “needles” from stones, to bronze, to iron, to the stainless steel disposable needles we use today. The latest major innovation was the introduction of electrical stimulation to the needles.

There is a discrepancy between the origin stories of electroacupuncture. Whether it started in early 19^th-century Europe, 1940s Japan (we do know they were doing an awful lot of experiments during World War II), or in China 1934, with the publication of “The Technique and Principles of Electro-acupuncture,” it is the most recent major innovation in the multi-millennial history of acupuncture. So when venturing to research acupuncture, why not use the “latest version” of it?

Electroacupuncture does seem to be more effective than manual acupuncture when treating pain. Since pain is probably the most common medical concern, it’s what gets studied the most; hence, the predominance of electroacupuncture studies. But remember that acupuncture, in general, treats much more than just pain.

The reason that electroacupuncture may, in some cases, be more effective than manual acupuncture is that electroacupuncture adds more energy to the body; whereas, manual acupuncture relies on piezoelectricity that is produced by your own body. (When treating pain syndromes in my practice, I don’t always use electroacupuncture; the choice depends on the severity, duration and nature of pain, and the constitution of the patient.)

Finally, standardization is key when it comes to being able to reproduce research results. And it is easier to standardize electroacupuncture by specifiying the frequency (Hz) and intensity of stimulation; whereas manual acupuncture requires active lifting, thrusting and twirling of the needle, making standardization difficult.

–oids

During acupuncture, once the ion channels are opened, other effects can be detected; like the recruitment of the opioid and cannabinoid systems.

The opioid system is most commonly recognized for its involvement in pain relief. However, it has also been shown to offer neuroprotection and help regulate ionic homeostasis, cell division, regeneration, emotional response, immunity, appetite and metabolism, respiration, and heart function. (Feng, 2012)

There are three main opioid receptors, mu- (MOR), delta- (DOR) and kappa- (KOR) that produce their effects when bound by opioids. A fourth receptor, opioid receptor-like orphan (ORL), was later recognized, and it is much less understood than the original three.

The endogenous opioids (produced by the body) are constructed of amino acids. They are known as endorphins, enkephalins and dynorphins. Their selectivity for particular receptors varies, except that dynorphin is strictly a KOR agonist (i.e. binds to).

The cannabinoid system has been popularized by the marijuana movement because it is responsible for the effects of THC and CBD (chemicals derived from marijuana). Like the opioid system, the cannabinoid system provides neuroprotection and helps regulate pain, emotions, appetite, and metabolism, in addition to motor coordination.

The most well-known cannabinoid receptors are labeled CB1 and CB2. CB1 is predominantly found in the central nervous system. Outside of the brain and spinal cord, CB1 plays a minor role; whereas CB2 is considered to be active only in the periphery (though there are studies that propose some CB2 expression in the brain).

The endocannabinoids (produced by the body) are constructed of fatty acids; mainly arachidonic acid, though other fatty acids may be involved. The most understood endocannabinoids are anandamide and 2-AG. Anandamide is commonly thought to be a weak agonist, while 2-AG strongly binds to both CB1 and CB2 receptors.

Because the opioid and cannabinoid systems share neuroanatomical and physiological characteristics, and they are both heavily involved in addictive disorders, it is assumed that they interact. While the nature of the opioid-cannabinoid interaction is not well-defined, the effects of acupuncture may help shed some light.

Acupuncture Studies

In a study on persistent pain, electroacupuncture caused the release of opioids from immune cells near inflammatory sites. (Zhang, 2014) This may be due to the same consequence of piezoelectric stimulation, i.e. depolarization of the cells leading to a specific action. It also activated sympathetic (fight-or-flight) nerve fibers, which may enhance the migration of endogenous opioids.

Regarding opioid-cannabinoid system interaction, the same study showed that electroacupuncture also enhanced the expression of CB2 receptors in inflamed tissue. While production of endocannabinoids was not observed, it did find that the expression of CB2 receptors up-regulated the production of opioids. This CB2-opioid effect is corroborated by a separate study unrelated to acupuncture. (Ibrahim, 2005)

During electroacupuncture, the frequency affects which opioids are released. Low frequency (2 hz) produces enkephalins and endorphins. High frequency (100 hz) produces dynorphins. Moderate frequency (60 hz) produces all three types of opioids. They all have analgesic effects, but dynorphin appears to be most effective for spinal cord lesions.

As evidence of effects other than pain relief, a study on neuroprotection showed that electroacupuncture increased the production of anandamide and 2-AG. This helped protect the brain from ischemia (diminished blood supply) through the binding of the endocannabinoids to CB1 receptors. (Wang, 2009)

The “Bridge”

At a maximum speed of nearly 270 mph, nerve signals must pass through numerous junction points. These junction points are called synapses, and they are where nerves meet other nerves or muscle fibers, or some non-neuronal cells. The gap between these structures is known as the synaptic cleft. Nerves send neurotransmitters across that gap to relay the messages.

Opioid and cannabinoid receptors help control the neurotransmitters that are released. So, essentially they can edit the messages.

My initial title of this post was, “Acupuncture Bridges the Synaptic Cleft.” This alluded to how acupuncture helps the flow of Qi (electrical signals, neurotransmitters, messages) along the neuro super-highway by activating the –oid receptors located at synapses.

However, since the action of the receptors is mostly inhibitory, a drawbridge would be a better metaphor for acupuncture’s facility here; in that acupuncture helps hold back the flow of certain neurotransmitters across the synaptic cleft.

For example, in the peripheral nervous system, “substance P” is the neurotransmitter responsible for sending pain messages. Its release from the synapses is prevented when endorphins bind to their receptors, stopping the pain signal. In the central nervous system, GABA is inhibited instead of substance P, which leads to an excess of dopamine.

The actions of the cannabinoid receptors are less clear; for CB1 receptors can have both an inhibitory or excitatory effect on dopamine production. (Hernandez, 2015)

*The image above is my tribute to Chicago, the gears beneath the old Chicago Avenue drawbridge (demolished in 2018).

References

Cheng, Li-Li, et al. “Effects of Electroacupuncture of Different Frequencies on the Release Profile of Endogenous Opioid Peptides in the Central Nerve System of Goats.” Evidence-Based Complementary and Alternative Medicine, vol. 2012, 2012, pp. 1–9., doi:10.1155/2012/476457.

Feng, Yuan, et al. “Current Research on Opioid Receptor Function.” Current Drug Targets, vol. 13, no. 2, 2012, pp. 230–246., doi:10.2174/138945012799201612.

Han, Ji-Sheng. “What Is the Best Parameters of Electroacupuncture (EA) Stimulation for the Treatment of Pain and Drug Addiction.” The Medical Acupuncture Web Page, 10 May 2019, med-vetacupuncture.org/english/icmart/icm98abs/abs3.html.

Hernandez, Giovanni, and Joseph F. Cheer. “To Act or Not to Act: Endocannabinoid/Dopamine Interactions in Decision-Making.” Frontiers in Behavioral Neuroscience, vol. 9, 2015, doi:10.3389/fnbeh.2015.00336.

Ibrahim, M. M., et al. “CB2 Cannabinoid Receptor Activation Produces Antinociception by Stimulating Peripheral Release of Endogenous Opioids.” Proceedings of the National Academy of Sciences, vol. 102, no. 8, 2005, pp. 3093–3098., doi:10.1073/pnas.0409888102.

Katia, Befort. “Interactions of the Opioid and Cannabinoid Systems in Reward: Insights from Knockout Studies.” Frontiers in Pharmacology, vol. 6, 2015, doi:10.3389/fphar.2015.00006.

Lu, Hui-Chen, and Ken Mackie. “An Introduction to the Endogenous Cannabinoid System.” Biological Psychiatry, vol. 79, no. 7, 2016, pp. 516–525., doi:10.1016/j.biopsych.2015.07.028.

Reggio, Patricia. “Endocannabinoid Binding to the Cannabinoid Receptors: What Is Known and What Remains Unknown.” Current Medicinal Chemistry, vol. 17, no. 14, 2010, pp. 1468–1486., doi:10.2174/092986710790980005.

Samson, Maria-Teresa, et al. “Differential Roles of CB1 and CB2 Cannabinoid Receptors in Mast Cells.” The Journal of Immunology, vol. 170, no. 10, 2003, pp. 4953–4962., doi:10.4049/jimmunol.170.10.4953.

Sprouce-Blum, Adam, et al. “Understanding Endorphins and Their Importance in Pain Management.” Hawai’i Medical Journal, vol. 69, Mar. 2010.

Wang, Qiang, et al. “Pretreatment With Electroacupuncture Induces Rapid Tolerance to Focal Cerebral Ischemia Through Regulation of Endocannabinoid System.” Stroke, vol. 40, no. 6, 2009, pp. 2157–2164., doi:10.1161/strokeaha.108.541490.

Zhang, Ruixin, et al. “Mechanisms of Acupuncture–Electroacupuncture on Persistent Pain.” Anesthesiology, vol. 120, no. 2, 2014, pp. 482–503., doi:10.1097/aln.0000000000000101.

Image by ‘Toms’ Balcus (flickr/photo-toms), CC BY-NC-ND 2.0

Acupuncture is commonly explained in terms of a network of energy meridians or channels. This network is a convenient map of all the points that can influence the body’s functions. The benefit of energy meridians is that they visually integrate the body so that it may be seen as a single unit rather than a collection of isolated parts. But physically isolating these meridians has been elusive.

Less elusive, is thinking of this energy network as a series of ion channels and synaptic clefts. Ion channels are the pathways through cell membranes that allow charged particles (ions) to flow and the cells to function. Synaptic clefts are the spaces between neurons and tissues that charged particles and neurochemicals flow through, resulting in the propagation of nerve signals.

In this light, we can still view the body as integrated. But as a unit of cells rather than meridian lines, that communicate with each other via electrical energy. We are literally bioelectric plants, and acupuncture helps maintain our circuits. Thinking in terms of cells also helps us understand how acupuncture works.

It is said that acupuncture helps restore body functions. But how? Well, how does a cell function? It is dependent on the state of charged particles within the cell. The current state is the script that the cell follows in order to act a certain way. Acupuncture affects the electrical state of cells by way of piezoelectricity.

Piezoelectricity is produced in our bodies by proteins in our connective tissue that are capable of converting mechanical energy into electrical energy. Tissue fibers wind around an acupuncture needle after insertion. When that needle is manipulated, a mechanical force is applied. This is transduced into an electrical impulse that opens the ion channels on cells, and thus mediates body functions. [For more on the piezoelectric effect, read: “The Spark in the Machine: How the Science of Acupuncture Explains the Mysteries of Western Medicine”]

In local needling (i.e. needling at the site of dysfunction or pain), it may be understood how an electrical impulse can pass between adjacent cells that have the same function. This is less evident in distal needling, or needling away from the site of dysfunction or pain. 

The mediation of body functions also relies on the cascade effect. This helps explain the effectiveness of distal needling. Aside from any local effects, the force applied by needling can be transferred along connective tissue planes to areas relatively far away from the needle site. (Tension along connective tissue planes often overlaps with acupuncture meridians.) Wherever that force ends up, the same piezoelectric principle applies.

A cascade effect can also occur through the circulatory or nervous systems. As changes take place, hormones or ions may travel in the bloodstream to give feedback to either a vital organ or the central nervous system. Information may also travel along the nerves themselves.

Whether local or distal needling, the connective tissue is the lynchpin of acupuncture’s effectiveness.

This is Part 1. For the effect of acupuncture on opioid and cannabinoid receptors, read, “Acupuncture Bridges the Synaptic Cleft.”