Hormone replacement therapy (HRT) drugs have been in the news in the UK lately, because of the shortage of some HRT products, particularly oestrogen. About one million women in the UK use HRT to cope with menopausal symptoms such as hot flushes, night sweats, insomnia, decreased libido, anxiety and poor concentration.

The good news is that Chinese medicine offers a safe and effective alternative to HRT. Systematic reviews and randomised controlled trials (which are the strongest types of research evidence) found that acupuncture is at least as effective as, and sometimes superior to, hormonal drug treatment. 

In my clinic I regularly give acupuncture treatment to women who need help for menopausal symptoms. About 30-70% of women in Western countries will experience vasomotor symptoms (related to constriction or dilatation of blood vessels) like hot flushes or night sweats. In extreme cases they might have been experiencing these for decades. The median duration for vasomotor symptoms is about four years, but in 10% of women, they last longer than 12 years. 

I see myself as walking proof of how Chinese medicine can help those transitioning through menopause, one of millions of women around the world. I manage the symptoms with regular acupuncture and Chinese medicine herbs, along with healthy food choices, regular exercise and stress reduction. And maybe more importantly, it's about appreciating this next stage in my life. Menopause doesn't have to be such a scary word. I'm older and wiser, and that brings with it confidence and serenity. 

Of course I am mindful that I am fortunate to enjoy good health. To some degree it's about luck (i.e. genetics), but there's a lot that middle-aged women can do to help ourselves.

Photo credit: yochim from Free Images

I don't know about you, but my family and I have been in coronavirus lockdown for 25 days (first in self-isolation, then in semi-lockdown along with the rest of the UK) and I am starting to feel a niggly ache in the back. And I am hearing this a lot when I talk to friends and colleagues, who say they have stiffness or pain in joints as a result of sitting a lot.

If we were already, as a society, sitting too much before, then this is certainly the case now as movements are restricted to however many rooms you have in your living space. In the UK, we're allowed to go out once a day for exercise, shopping for essentials, medical appointments, and essential work. Assuming we sleep eight hours a day, that leaves us 14-15 hours a day potentially sitting down a lot!

One solution is to invest in a standing desk. But if you look at amazon, for example, stands desks are neither cheap nor always in stock. Yesterday a friend of mine suggested using your bog standard ironing board as an adjustable desk for a laptop.  

I like to set an alarm so that every hour, I am reminded to get up, stretch and move. Make a cup of tea! Or better yet, offer to make others cups of tea. Everyone knows that a good cuppa is all you need to make it all okay.

In terms of supported exercise, of course you have a plethora of Youtube exercise channels and yoga webinars to choose from.

However, if you fancy doing a more gentle exercise that is good for circulating and generating energy and requires no specialist equipment, do give qi gong a try. Qi gong is a system of energetic and healing exercises from ancient China that integrates principles of relaxation, movement and breathing, especially helpful during these days of self-isolation. My colleagues and I at the School of Tai Chi Chuan London are running free weekly webinars at 6pm (London time) on Tuesdays. No previous experience necessary. 

If you'd like to give qi gong a try, please email me and I will send you a link to these online gatherings.

I recently wrote about my friend Maria, who came to visit and stayed for two weeks while I gave her intensive acupuncture treatment for chronic fatigue and fibromyalgia. One of the things that struck me was how for years, she was prescribed very strong opioids like OxyContin. Opioids are a class of drugs that are prescribed to relieve persistent or severe pain, and include morphine and codeine. We know now that opioids are addictive and side effects are numerous, including increased pain. The US is in the grip of an opioid crisis, and abuse of these drugs has caused tens of thousands of deaths a year.

Part of the response in the US has been to push non-pharmaceutical options for pain control. This is when Chinese medicine can be invaluable. For example, the US Food and Drug Administration (FDA) and the National Academy of Sciences, Engineering and Medicine (NASEM) recommend acupuncture as a first-line therapy for coping with the opioid crisis because it is found to be effective, safe and cost-effective for numerous types of acute and chronic pain.

In the UK, there is no official support for acupuncture or other unconventional treatment options to opioids. Acupuncture primarily sits outside the National Health Service, so people usually pay privately for treatment. But people come for treatment because they hear about it from friends and family. The evidence is also clear about the effectiveness of acupuncture for 117 conditions.

In my day-to-day practice, about a third of patients come for pain, usually for musculoskeletal or neurological reasons. It is wonderful seeing someone walk out of clinic a different person, one in less pain, more relaxed, and with a smile on their face. Because this is what I do every day I sometimes take acupuncture for granted, but it is a truly remarkable system of medicine.

​Photo by Dima Vishnevetsky from FreeImages

When an old friend from Manila - let's call her Maria - got in touch six weeks ago to ask if I can help with fibromyalgia and chronic fatigue, I said yes of course. But when that friend said she will stay in London for two weeks to have acupuncture treatment, I was bowled over by her trust and commitment.

So over these past two weeks, I saw Maria roughly every other day to give her acupuncture. She has suffered from a debilitating constellation of low-grade fevers, muscle/joint aches and pains, sweating, and fatigue for the past 15 years. But it had worsened significantly in the past two years so she could barely walk a few minutes without getting wiped out. All that conventional medicine doctors could offer were painkillers, steroids and antidepressants - at one point Maria was told there was nothing they could do for her any more.

When I told my friend that of course Chinese medicine can help, it's because it sees auto-immune conditions as difficult but not impossible to treat. The incidence of auto-immune diseases such as fibromyalgia, multiple sclerosis, lupus and rheumatoid arthritis has been on the rise, and there is universal agreement among scientists that industrial toxins and chemicals in the environment are interfering with the functioning of our immune systems. According to the UK's National Health Service, fibromyalgia (a long-term condition that causes pain all over the body) is estimated to affect one in 20 people.

I focused on releasing the fever, lowering her temperature, removing toxins, and easing the aches and pains in her body. And over the past two weeks, Maria has got stronger as the sweats and fever abated and pain reduced. Chinese medicine focuses on lifestyle choices as well - part of Maria's work is making changes to the food she eats (her daily medicine!) and learning Qi Gong (Chinese internal exercises that focuses on breathing and simple movements) to circulate and generate energy, allowing her to get stronger and manage her condition.

It was wonderful to see the shift in Maria's energy levels in a short space of time. She was grateful because she hasn't felt this well in 10 years. But I was also grateful to have had an opportunity to see how intensive treatment can work with someone so committed to getting better.

Photo by Christian Fregnan on Unsplash

Six weeks ago, I went to bed with an achey left shoulder, felt the pain getting more intense through the night, and woke up the next day to a frozen shoulder. Also known as adhesive capsulitis, frozen shoulder is exactly what it says on the tin — the shoulder gets stiffer and achier over a period of 2-9 months (freezing phase); the pain gradually subsides but the shoulder is stiff and movement is restricted, which lasts about 4-12 months (frozen phase); the shoulder becomes less stiff and range of movement increases, which takes 1-3 years (thawing phase).
 
No one knows why shoulders freeze, although previous shoulder injury or trauma plays a part. More women than men are afflicted. The incidence of frozen shoulder is 2 to 4 times higher in those with diabetes than in the general population. What I do know is: a) it is very painful, and b) everyday activities like washing your hair, putting on a shirt, and driving a manual car become impossible.
 
The irony is not lost on me that I spend a large part of my working day treating patients with painful necks, shoulders and backs, when I myself can hardly lift my left hand without grimacing!
 
But here is the upside (and because I am an inveterate optimist, there is ALWAYS an upside). I know that for me, regular acupuncture, osteopathic treatment, stretching/strengthening exercises, as well as my tai chi practice, are key to getting more movement and reducing pain and inflammation. I also have more empathy with patients in pain. Let’s face it, pain makes you grumpy. It has a way of reducing even the sunniest personality into a blubbering mess, I get that. 
 
I also understood that there is an emotional component to a frozen shoulder. When you are going through a difficult time — whether at work or at home — you might hold yourself tight and stiff without realising it. When this goes on for years and years, this means less blood and qi (energy) circulating, which means less nourishment for muscles, tendons, ligaments and joints. Over a period of time, a vulnerable shoulder freezes. 
 
During the very painful stage, my wise osteopath advised me to see my frozen shoulder not as a problem to be fixed but rather as a healing journey that I have to go on. I know now that it helps to have patience (it might takes years to resolve), be kinder to myself (what’s the use of asking what could have been done to prevent it), and rediscover my sense of humour (the advantages of not being able to do certain chores!).

When I was a kid growing up in the Philippines, I adored my Lola Sion, my dad’s mum. She was a respected figure in the community, was a teacher in the local school, and brought up seven children single-handedly after the Second World War (my grandfather, Lolo Juan, died of tuberculosis in 1950). She also slipped coins under her grandchildren’s pillows at night while they slept, and when we showed her the coins in the morning, claimed there is a magic bullfrog that did the rounds at night (perhaps her version of the tooth fairy), but that is for another blog.
 
I’ve been thinking of Lola Sion recently as I read an article* about how tai chi may help prevent osteoporosis in post-menopausal women. Lola Sion was an active woman in her early 70s, but an accident caused her to fall and break her hip bone. I don’t know if she had osteoporosis (post-war diet in rural Philippines may not have been very rich in calcium), but she never recovered from her broken hip and was bed-ridden for two years before passing.
 
Nowadays of course we know that a balanced diet and regular exercise help slow the loss of bone density and delay or prevent osteoporosis (a bone disease that occurs when the body loses too much bone, makes too little bone, or both). Studies suggest that about one in two women and up to one in four men age 50 and older will break a bone due to osteoporosis.
 
Medications and hormone replacement may also be used to fight osteoporosis. But all medications have side effects. Why not try a form of exercise that is fun, relaxing and has many health benefits?
 
I am talking about tai chi, which according to the US National Institutes of Health*, may help maintain bone mineral density. T’ai chi places great emphasis on standing single-weighted (all the weight in one leg), which stimulates bone growth. One of the senior teachers in my school of tai chi, Margaret Matsumoto, had a bone density scan at age 60 and her hips showed the same bone density as a healthy 30-year-old!
 
The London School of T’ai Chi Chuan is offering free introductory sessions on September 19th and 20th in central London. Come along and see what tai chi and studying with us is like. We will tell you about the background of our school, some of the benefits of doing tai chi (not just for osteoporosis!), introduce you to its basic principles and have a taster class. Click here for details. All welcome!

I wonder what Lola Sion would have made of this ancient Chinese exercise? Now there’s a thought.
 
* Wayne, P.M., Kiel, D.P. and Krebs, D.E. (2007) ‘The effects of tai chi on bone mineral density in postmenopausal women: A systematic review’, Archives of Physical Medicine and Rehabilitation.

My classmates and I have spent almost two weeks now in Dr Bi's clinic, so we have come to know his patients well. They come everyday for problems with the neck (cervical spondylosis) and lumbar pain. Daily treatment is the norm for musculoskeletal problems in China, which is much more effective -- quite a big difference from how patients come once (maybe twice) a week in our clinic in London. Acupuncture is expensive in the UK, and more often than not patients are paying out of pocket, so daily treatment is not often viable.

It has been such a learning experience to see Dr Bi's needling and massage techniques, choice of points, and how he manipulates necks and backs. But the lasting impression that I have of this bustling clinic is its beautiful communal atmosphere. Photos cannot capture this special quality.

For starters, the patients come everyday so they get to know each other and the doctors and students well. They spend a lot of time getting treated with acupuncture, massage, cupping, guasha (scraping the skin, especially of the back), and electro therapy, usually staying there 2-3 hours at a time. So there is a lot of time to talk, and talk they do!

They talk about how they are feeling and how their treatments are going. They inquire about each other's family, especially their children. When there is a new patient, they are listening to what's going on (because the consultation with the doctor is happening in front of everyone). And they  probably talk about us, the foreign students who are here to absorb as much of Dr Bi's Chinese medicine knowledge as possible in the time that we have.

This morning was particularly beautiful. Dr Bi was alone in the clinic with about six patients. For some reason his students and junior doctors were late to come in, so he had to look after patients by himself. I noticed that the son of a woman patient (he accompanies his mum every day) was helping hook up one lovely older lady to an electro therapy machine -- I guess because he is in the clinic with his mum so often, he knows from observing what to do! 

It is such a stark contrast to how acupuncture is administered in the UK, where you normally treat one patient at a time in individual treatment rooms. I will really miss the happy and healing atmosphere in the outpatient clinics here in Heilongjiang University of Chinese Medicine. Maybe I can recreate this by working in a multi-bed clinic back home?

This week, my classmates and I have been following Dr Bi Xu-wei of a strangely named department called Health Care. I thought at first this would be similar to a General Practitioner (GP) surgery (or primary care in the UK), but it turns out to be a cross between rehabilitation and Chinese massage (tuina).

The majority of Dr Bi's patients have cervical spondylosis (compression of the neck vertebrae) and lumbar disc hernia (or slipped/prolapsed disc). The armoury of Chinese medicine here includes tuina, acupuncture, moxibustion (the burning of rolled up mugwort herb to warm up an area to promote Qi and Blood circulation), cupping, and electrotherapy. Dr Bi is a great doctor to follow because he specialises in conditions that I will see a lot of when I am in practice. He is also very kind and generous with his knowledge.

Yesterday a patient came to see him with a frozen shoulder -- he immediately stuck a needle in her lower leg (Tiakou ST38), quite deep, at least 3 cun (6cm). This was obviously painful for the patient, but at the same time she gained instant relief from the pain -- you could see this in her face. It took me a few seconds to figure out what was happening. I have read about ST38 being used with dramatic results, but this is my first time to witness it for myself.

I often suffer from frozen shoulder, usually when it's cold and I'm too busy and have no time to exercise and stretch. I have a vested interest in frozen shoulders! Today I asked Dr Bi to look at my right shoulder, which has been aching for the past six months. He said it's not frozen but I might have cervical spondylosis. 

Dr Bi then needled two points on my hand (Sanjian LI3 and Hegu LI4), again going in very deeply. The sensation was electric, and like yesterday's patient, I got instant relief from the ache. He massaged my upper back, neck and shoulders and mobilised my shoulder, and now I am walking around like a new woman, a complete fan of this great doctor.

Later on he told me and my classmates -- after he had shown us a secret point near the thumb for headaches -- that he doesn't mind sharing his secrets with us because we are from the UK. I gather that he doesn't share so readily with people from Harbin because competition in the hospital is quite fierce! 


 

Back in April, I was told by my boss that I would need to work full-time or not at all. Considering that I am in full-time studies, working five days a week was never going to happen. So I tried not to worry (because worry affects the Spleen and injures the Heart, but that's for another blog entry) and thought I would leave for my hospital placement in Harbin in August and look for a new job in the new year. Big gulp!

But the gods are smiling, because a month ago my bosses said there's a position open for me if I were interested. Something completely different -- carrying out research analysis for my colleagues around the world. I would be based from home, working three days a week, with a four-month sabbatical so I can go to China. Yes please, I said, thank you very much. It sounds perfect!

The new role, I am happy to say, is working out well. My commute consists of a dozen steps from the kitchen to the spare room, I have no transport expenses, and coffee and tea are free. The only downside is I am by myself the entire day and completely tied to the computer. But even when I am talking to colleagues and clients, it's via Skype and I am still typing away on the keyboard. It didn't take long for my back to become unhappy.

Holy camole, I spend half my time in clinic sorting out patients' bad backs, shoulders and necks -- musculoskeletal pain is an acupuncturist's bread and butter -- and here I am, in danger of doing my back in because I am immobile for eight hours a day.
 
From a traditional Chinese medicine perspective, back pain is Qi and Blood Stagnation of the Bladder channel (if it runs down the back) or Gallbladder channel (if the pain extends down the side of the leg), or whatever channel or pathway is affected. Everything feels stuck , and needles placed in the right points help the body unblock those places of stagnation.

Fortunately no one can see me so when I take my hourly breaks, I can be found on the floor doing stretches. If you are desk-bound, set your alarm to go off every hour and go for a nice stretch, make a cup of tea, water the plants. Whatever you do, get up and do something different. Otherwise years of being hunched in front of a computer will send you to an acupuncturist because plenty of research shows that acupuncture is effective for chronic back pain.