Health Column October 2018
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Do You Know How to Choose Medicated Plasters for Pain Relief? A Guide to Medicated Plasters in Western and Traditional Chinese Medicine 
by  Dr. 蔡育霖
In Taiwan, medicated plasters are second only to oral anti-inflammatory medicine in terms of the number of people using them to relieve muscle and bone pain. Medicated plasters are commonly prescribed at pharmacies, hospitals, and clinics. At the hospital, a medical professional can help you determine if you should use a medicated plaster, and if so, which kind. Do you know how to choose on your own when purchasing them?  This article will introduce the principles of plaster usage as well as selection methods in Western and Traditional Chinese medicine. The next article will introduce details about the ingredients in Western plasters, Traditional Chinese medicine plasters, and external creams.

Principles of Western and Traditional Chinese Medicated Plasters and External Creams
  1. Medicated plasters contain anti-inflammatories, so take note of your usage. Regardless of whether you're using plasters, rubs, or sprays, only apply one type of medicine at a time to avoid overdosing. In addition, avoid using on large areas. Using more than two plasters on one body part in the same day is not recommended.
  2. Don't use medicated plasters on areas where you have wounds.
  3. If your skin breaks out in an allergic rash after use, stop using and consult your doctor right away.
  4. The pain relief ingredients in the plaster are absorbed through the skin. As skin is prone to redness, swelling, and itching when not exposed to air, prolonged use is not recommended.
  5. If your pain symptoms have been relieved, stop using medicated plasters to avoid becoming dependent.
  6. Children and pregnant women should consult their doctor before using medicated plasters and should use Western medicine plasters with simpler ingredients to lower the risk of side effects.
  7. Remember to check that the medicated plasters you are purchasing are legal and up to standard!
Medicated Plasters in Western Medicine: Choose Based on Pain Type
In broad terms, medicated plasters rely on NSAIDs (non-steroidal anti-inflammatory drugs) to provide relief for pain and inflammation. If your pain is caused by 
soreness or inflammation, anti-inflammatory pain relief will have better results. This includes muscle strains, contusions, or injuries from a fall. If it is a new injury with light symptoms, you can purchase medicated plasters on your own to take care of it. If your back is sore due to prolonged sitting, or you suffer from psychogenic pain or long-term neck soreness, medicated plasters may not be as effective, because these pains are not caused by inflammation. For chronic pain issues, we recommend that you change your lifestyle habits, stretch, and exercise regularly. If your condition is serious, seek the help of a physical therapist specializing in chronic pain or a pain management doctor. Generally, medicated plasters in Western medicine are suitable for acute pain. 

Materials Used in Medicated Plasters
Oil-based plasters are thinner and stickier, but they are more likely to cause allergic reactions due to the usage of organic solvents.
Water-based plasters are thicker and less sticky, so they fall off more easily, but they are also less likely to cause allergic reactions.

How to Choose Medicated Plasters and External Creams Used in Traditional Chinese Medicine
Medicated plasters and external creams in Traditional Chinese medicine are categorized according to early or late stage injuries similar to Western medicine.  The difference is that in Traditional Chinese medicine, there are plasters and external creams available for each stage of injury or pain, and they use different ingredients to achieve different results. The principles of treatment are based on the holistic diagnosis and treatment method used in Traditional Chinese medicine, which simultaneously treats the issue internally and externally. Out of respect for Traditional Chinese medicine's usage and context, the following introduction is mostly unedited.   

Early Stages of a New Injury (1-2 weeks):
At this stage, injuries to sinew, bones, and veins have led to blood stagnation in the affected channel; accumulation of stasis, blood,
qi ; and meridian blockage. Thus, the primary treatment method is to promote qi flow to remove stasis and swelling and release pain. In this stage, "cooling patches" containing wintergreen oil and menthol are the best treatment choices. Wintergreen oil contains salicylate, which provides relief for inflammation and pain; menthol stimulates the central nervous system, causing the skin's pores and blood vessels to expand. This causes sweating, which has clearing heat and pain relief effects. External creams may include Sanhuang, Xiao Yan Tong Gao, or medicated and water-based plasters; when red heat symptoms are present, Sihuang San or Qingying edema cream may be used for their stronger heat-clearing properties. If swelling and pain are not serious, or swelling has already begun to recede, creams to relax muscles and stimulate circulation such as Wanhua oil, herbal balm, or anisette may be used. 

Late Stage Injuries:
At this point, stasis and swelling have receded, bruises have yellowed, and pain and dysfunction are gradually improving. Full recovery can be expected in 3-5 weeks. Late stages of a new injury, old injuries, and long-term pain are more suitably treated by warming channels to promote qi circulation, such as using heating plasters. In addition to wintergreen oil, these plasters contain capsaicin, aconite root, and
drynaria fortunei (gu sui bu), causing a heating sensation on the skin after applying. External creams include Baozhen or Wanying creams; injury baths, Baxian Xiaoyao soup, or erythrina bark (haitongpi) soup may be used to steam and wash extremities. It is important to remember that the ingredients in Chinese medicated plasters and external creams are relatively more complex. Children and pregnant women are recommended to consult with their doctor or pharmacist before using medicated plasters or to choose Western plasters with simpler ingredients. 

A Review of Keys to Purchasing and Using Medicated Plasters:
  1. Western medicated plasters are suitable for acute injuries and pain. They are not effective for old injuries or chronic pain.
  2. Oil-based plasters are thinner and stickier, but they are more likely to cause allergies. Water-based plasters are thicker and less sticky, but they are less likely to cause allergies.
  3. In Traditional Chinese medicine, cooling plasters are best suited for early-stage new injuries, and heating plasters are best for late-stage new injuries, old injuries, and chronic pain.
  4. Only apply one type of plaster at a time, and don't use on a large area. Do not use more than two plasters on the same body part in one day.
  5. If you experience skin discomfort, discontinue use immediately and consult your doctor.
  6. Do not use plasters for too long; as soon as your condition improves, stop using pain relief plasters.
  7. Children and pregnant women should consult their doctor before using plasters.
  8. Only buy up to standard, legal medicated plasters.
Please be careful when selecting medicated plasters. Making the wrong choice and wasting a bit of money is nothing, but overdose, redness and swelling, allergic reactions, and use of illegal products could be serious.
Retrieved from: 好痛痛 - 復健科、骨科、物理治療醫療資訊

Shoulder, Neck, and Waist Pain for Officer Workers
by  楊庭安, PT

According to research conducted by the founder ofEasePain, who is experienced in data science, EasePain articles are mostly read on weekdays, either during or after work hours. Other research shows when people talk about subjects regarding pain, posture, or a herniated disc, they would immediately adjust their posture...and maintain it for about five minutes. With these two points in mind, we thought we could write some articles about common problems that office workers suffer from. When people read these articles in the office, hopefully, they will become more aware of the need to improve their work habits. We also encourage you to remind your colleagues not to remain seated for too long whenever you read this series of articles.
Today we will be discussing neck, shoulder,
and waist pain. These are common problems, and, interestingly, they are more likely to occur on weekdays. On weekends, the pains are likely to become alleviated or even stop. During weekdays, people often don't experience any pain when they first sit down. However, as time progresses, the pain starts to creep in and become more intense. If they change postures, things would seem to be fine.

There are many similarities among people who experience these problems:
1. Their work requires them to remain in a seated position for long periods of time.
2. They often maintain the same posture without moving.
3. They need to look down at a computer screen or do paperwork for long hours.

Usually, these problems arise due to poor posture over a prolonged period of time. However, if you've been a fan of EasePain for a while, you'll surely ask, "But haven't you posted an article on how posture isn't necessarily related to pain?" 
Indeed, we did. However, in that article, we were referring to dynamic posture. In other words, when you're in constant movement, your posture won't make a huge difference. On the other hand, when you're required to be seated all day, your posture will start to play a role in your pain.

Common Posture Problems
If you're in the office now, turn around and see if you can observe these common posture mistakes in your co-workers when they're seated.

If you just took the opportunity to check out the cute girls or guys sitting near you, good for you! Nevertheless, if you or your colleagues are seated in these positions, what problems may arise in the long run?
1. Overly-curved lumbar spine or thoracic spine.
2. The back muscles are forced to stretch due to the bent thoracic spine. At the same time, these muscles are overburdened because they are in constant isometric contraction in order to maintain stability.
3. As you tilt your head forward, the nape muscles have to exert more force to support your head. When the thoracic muscles are tightened and constricted, the upper crossed syndrome is more likely to occur and induce pain.

According to research in biomechanics, the lumbar vertebrae are subjected to more pressure in a seated position compared to a standing or lying position. The pressure may cause the loss of fluid content in the intervertebral discs. The loss of fluid may lead to accelerated regression. Also, the pressure may contribute to an increased likelihood of a herniated disc.

Your vertebral column actually works like a geared device.
Swiss neurologist Brugger pointed out in 2000 that poor posture is a chain reaction in the vertebral column. When one segment of the spine starts to incline, other segments will be affected and become off-kilter. The different segments of the spinal column in
fact perform like meshing gears.

Image credit:

So, what should you do?
First and foremost, don't stay seated all the time! We strongly recommend that you stand up and take a walk every 30 minutes or one hour.
"Of course I know that, but it just can't be helped when I'm busy at work," perhaps you would say in reply. It's true that specific types of work environment or personal condition may cause people to remain sedentary. For example, a hardcore engineer who is "in the zone" may work uninterrupted for 20 hours straight once they start coding. In this case, I suggest at least taking good care of your backbone
. Like I said, the vertebral column works like a geared machine. If you fix one part, other parts will be calibrated, too. For instance, you can place a cushion that fits you at the lower back area, or use an ergonomic chair. These measures will more or less reduce the chances of pain.

Still, we recommend not remaining seated for too long. Being seated for a long period of time in poor posture may also result in constricted breathing in the chest, rounded shoulders (anterior humeral glide), the constriction of the hamstrings, and disrupted digestive function. We will discuss further in future articles.

Retrieved from: 好痛痛 - 復健科、骨科、物理治療醫療資訊

Get to Know Chiropractic Medicine
by DPT Huang Guan-Wei

Chiropractic is a common treatment in Taiwan, where it is used in Traditional Chinese Medicine (TCM), Tuina, physical therapy, folk remedies, and even Western medicine. Chiropractic medicine was first developed in 1895 by US doctor Daniel David Palmer, and the United States offers formal chiropractic degrees and licenses, as well as a dedicated craft union. In Taiwan, the influence of Traditional Chinese Medicine theories and Tuina have led chiropractic medicine to develop differently compared to the US. Many people confuse folk medicine "adjustment" with chiropractic medicine, but they are actually quite different. Most importantly, chiropractic medicine is classified as a medical behavior and must be performed by a Western medicine doctor, TCM practitioner, or physical therapist.

This introduction to chiropractic medicine will cover questions such as:
1. What are the principles of chiropractic medicine?
2. Is "the louder the adjustment, the better the chiropractor" really true?
3. What are the risks of chiropractic treatment? What are some safety guidelines?
4. What is the difference between chiropractic and manual physical therapy?

Principles of Chiropractic Treatment
Chiropractic theory is based on neuroanatomy and biomechanics and applies manual or mechanical methods to adjust the spine, release pressure on spinal nerves, and promote normal nerve conduction. Less compression on the nervous system releases pain and relaxes muscles, as well as returning joints to their normal range of motion.
Does louder popping and cracking mean treatment is more effective?
Many people mistakenly believe that the cracking heard during a chiropractic session is the sound of joints returning to their correct position. This is not true. The cracking sounds are actually caused by synovial fluid in the joints; when the joints are pulled on, the pressure between them drops, causing the air dissolved in the fluid to turn into bubbles which then pop. Even MRI scans show this phenomenon. Thus, there is no correlation between these sounds and effective treatment. The most important factor is whether chiropractic treatment returns the spine to its ideal position and relieves discomfort.

Chiropractic Treatment Risks
Performing chiropractic treatment on the spine before fully understanding the underlying problem is dangerous and can cause injury to spinal bones and nerves. Before undergoing treatment, you should confirm whether you have any contraindications and take X-rays to better understand your spine's condition and decide whether chiropractic treatment is suitable.

You might be wondering, "How should I avoid this risk?"
It's not proper for a therapist to evaluate your spine's condition simply via touching to determine if chiropractic treatment is suitable. Allowing a non-professional to perform chiropractic medicine on you is not only risky but also illegal.
What is the Difference Between Chiropractic and Manual Physical Therapy?  There are many forms of manual therapy, but in general, they have the following effects: relaxing tight tissue, softening hard tissue, and returning joints to their correct positions.
When treating joints, common manual therapy goals include fixing problems caused by improper joint position, muscle, fascia, or tendon adhesion, and tightness. Using joint mobilization techniques on the spine to slowly loosen and realign spinal joints can have long-lasting effects and is quite safe. In addition, problems in surrounding areas can be examined during the treatment process to prevent joints from coming out of alignment as quickly. However, the effects of manual therapy or chiropractic adjustments alone are not permanent; complementing treatment with exercise is recommended for further improvement.

"So what's the best treatment option?!" Many physical therapists are asked this question. In reality, there are pros and cons to each of the many manual therapy methods out there. There is no "best method", only the method most suitable for you, and the therapist's skill level will also influence treatment effectiveness. An accurate diagnosis and evaluation is still the key to choosing the most suitable treatment method. If you are having pain problems, see a doctor first and undergo testing, and don't get your medical advice from unlicensed "therapists".
Retrieved from: 好痛痛 - 復健科、骨科、物理治療醫療資訊

Food for Thought: An Examination of Diet & Digestion
The Importance of Diet & Digestion


Even an acute poison can become an excellent drug if it is properly administered. On the other hand even a drug, if not properly administered, becomes an acute poison. — Charaka Samhita

In the above quote from the classical Ayurvedic medical text Charaka Samhita, the word "drug" can easily be changed to "food." One of the most common questions encountered in the clinical setting is, "What is the ideal healthy diet?" I personally do not believe there is a one single diet which is "the best" or "most healthy." A multitude of factors come into play when the concept of diet is considered—genetics, lifestyle, and cost, to name a few.

One of the key factors I target when asked this question is to evaluate the digestive capacity and digestive health of the patient. From a TCM perspective, this would be primarily the Spleen Qi / Yang (although many organs are involved) while from an Ayurvedic perspective this would be primarily the Agni. When patients ask me for the mythological perfect diet, I steer the conversation on to the topic of ideal digestion. An ideal diet is a diet that is digested well.

The Diet Craze
We can use the latest diet craze as an example. I see many patients who are now interested in trying or are currently using a Keto themed style diet. The overall standard breakdown for such a diet is 70-80 percent of calories from healthy fats, 20-25 percent of calories from high-quality protein, and 5-10 percent of calories from fiber-rich carbohydrates. The subject of a Keto diet is a large topic and will not be covered here; however, the basic nutritional structure of this diet can be used as an example of using digestive efficiency to determine the type of diet which may be best for a particular patient.

There are several standard ways to evaluate the health of the digestive system in Ayurveda and TCM, and these evaluations should be used with every patient's respective dietary approach. This is one of the most unique and important ways a TCM practitioner can help a patient above and beyond generic approaches to 
diet or to avoid falling prey to "diet cults" espousing a one-size-fits-all myopic approach. The basic foundational ideas of TCM must not be forgotten, abandoned, or replaced by novel clinical "tricks." To quickly and effectively evaluate the health of the digestive system in both TCM and Ayurveda, the tongue must be examined closely for color, shape, and coating. I will use the Keto dietary paradigm as an example. As mentioned earlier, the strength and efficiency of the digestive system must always be examined when a patient begins a new diet or is considering implementing a new dietary approach. Most patients turn to a Keto diet in an attempt to lose weight quickly and are usually switching to the Keto diet from a high carbohydrate-based diet. We know from TCM that the strength and vitality of the Spleen plays a fundamental role in the metabolism and digestion of carbohydrates. The sweet taste can potentially strengthen the Spleen or damage the Spleen depending upon the quality and quantity of the source of the sweetness—keep in mind there is a large difference between a sweet potato and a soft drink when the health of the TCM Spleen is considered.

The Keto Diet
Most often, in my clinical experience, individuals who are turning to a Keto dietary approach are most often consuming large amounts of sugars and/or suffer from blood sugar issues. The attractiveness of the Keto diet is the promise of a lower carbohydrate diet correcting such blood sugar issues resulting in weight loss, hormonal balancing, and insulin regulation. However, for this to occur, the patient must be able to digest the larger amount of healthy fats and high-quality proteins. In other words, the patient must possess strong Spleen Qi / Spleen Yang or Agni. To evaluate this, the tongue examination is crucial. Does the tongue have deep teeth-marks? Is the tongue body swollen? Is there a thick sticky coating on the tongue? Is the tongue body scarlet red? All of these factors should be considered when I patient is considering switching to a higher fat / higher protein diet.

If any of these issues are occurring with the tongue body/tongue coating, the clinician should council the patient on methods of foods, acupuncture, and herbal options to boost the Spleen Qi / Spleen Yang, clear Dampness, or clear Damp Heat and/or Liver Depression Qi Stagnation. This same evaluation of the tongue can be done as the patient follows the Keto dietary approach over a longer period of time as well.

If after weeks or months on the respective Keto diet, the patient's tongue begins to show teeth-marks, become swollen and/or have a sticky thick coating with a scarlet body, the patient should shift back to an easier to digest bland Spleen friendly diet. Attempting to treat these pattern presentations by herbal medicine or acupuncture alone are often not as effective as shifting the diet back to an easier to digest Spleen friendly diet. Clinicians can also use this approach for a patient on a higher carbohydrate diet as well. If the aforementioned tongue presentations appear on a higher carbohydrate diet, the clinician may counsel the patient to shift to a lower carbohydrate / higher protein diet until the tongue presentations shift back to a state of digestive balance.

Raw Foods
Clinicians can also use this method to evaluate patients following or considering following raw food diets. Raw foods can be very hard for the Spleen to digest and if any of the aforementioned tongue signs begin to appear in a patient on a raw food diet, the clinician should counsel the patient on an appropriate Spleen friendly diet shifting away from a raw foods diet until the tongue returned to a more normal presentation. By monitoring the health of the tongue before and during a significant dietary change, the clinician can help the patient avoid long-term problems or acute/future Spleen Qi issue.

We must remember in TCM that the Spleen is the root of a large array of health issues, acute and chronic. By monitoring the quality of the tongue body and tongue coating, the clinician can help the patient stay one step ahead of disease and discomfort and more effectively counsel patients nutritional questions while staying safely within the scope of practice for TCM practitioners. 

The Science behind the Efficacy of Cosmetic Acupuncture 
By Kim Perano, MSOM, L.Ac.

The beauty industry continues to 
boom and grow constantly, from topical creams, lotions and potions all the way to cutting-edge cosmetic surgeries. Some treatments simply fail at being effective, while others may be effective but very costly and invasive; and finding a more natural treatment that is actually effective can be a difficult task. Cosmetic acupuncture is a multi-faceted treatment, aimed at treating the entire person in a holistic approach.

Aging should be considered a chronic, whole body process, so when we are looking at how to slow down that process it is critical to look at the entire picture. Utilizing only a cream or serum will have limited effect if the person continues to smoke cigarettes, be perpetually dehydrated, or in a constant state of elevated stress.

Our lifestyle in 
and of itself, has a dramatic effect on how we look, so it should be no surprise that much of the benefit of cosmetic acupuncture lies in its' holistic approach. When we approach skin care and anti-aging skin care in particular, there are a few goals we need to keep in mind, and a treatment that adheres to these goals helps us administer effective skin care that produces desired results, while also avoiding injury to the skin structure so that the effects can last without repercussions later on.

Holistic Balance
First and foremost, we want to balance cell function in the body and skin.  This goal is often neglected in topical or medical beauty treatments because those treatments are only focusing on the skin and not the entire person. Acupuncture treatments for any condition help to stimulate this process of balance and being.

Physiologically the body is lowering oxidative stress, decreasing stress hormones, increasing cell longevity and ATP synthesis, and triggering dopamine release. Acupuncture helps to supply skin cells with the essential building blocks they require by improving digestion and regulating stress, this enhances the nutrition we receive from our food and also increases blood flow and lymphatic drainage to the face. The function of the full body acupuncture treatment can be considered anti-aging in and of itself due to its profound effects on regulating the body's response to stress.

Fibroblasts Are Key
Needling into the face also produces an incredible effect on the body and the skin itself. We can consider the process of needling the skin wounding the body, and our body's immune response to such a wound can produce an anti-aging effect when done precisely and correctly. A wound in the body - like that from an acupuncture needle - stimulates the division of fibroblasts - fibroblasts are responsible for making collagen, 
elastin and glycosaminoglycans (GAGs), which all cause ideal features in the skin - firmness, tightness, and plumpness, secondary to good hydration.

In the 
medical beauty world this process is usually stimulated by ablative therapies like IPL, chemical peels, fraxel laser etc. The problem here is that these treatments can also cause thinning of the epidermis plus loss of dermal papillae due to their overly invasive nature.2 Acupuncture needles are minimally intrusive to the skin, directly targeting the areas we want to see improvement in with intradermal needle threading in wrinkles. By stimulating the immune response through needling, we help to signal the cell what to do by releasing growth factors and stimulating fibroblast division. Through intradermal needling we can direct exactly where we want the body to send collagen, elastin and GAGs, thus producing an effect that helps to minimize fine lines and wrinkles.

Preserving Integrity
Great skin care aims to preserve the integrity of the epidermis. Acupuncture, 
microcurrent, and LED therapy are all minimally invasive treatments that maintain the integrity of the skin while simultaneously treating it. There is no downtime or peeling that occurs with the treatment, thus allowing the skin to remain fully intact and functional, offering the most benefit from the treatment without having to undergo a recovery period.

By preserving the integrity of the skin, we also preserve the dermal papillae, this layer is important in supplying the exchange of oxygen, nutrients and waste products between the epidermis and dermis, and is also responsible for providing strength between the layers.  When this layer is compromised, a separation between these layers occurs and this is how wrinkles are formed. Acupuncture needles produce minimal damage, the most common undesired side effect is bruising at needle sites, and the skin remains intact and strong, enhanced by the treatment as opposed to weakened by it.

Muscle Training
While all of the effects of a cosmetic acupuncture treatment produce wonderful results in a safe way for the skin itself, we cannot forget about the importance of the muscles of the face. The musculature of the face is complex, consisting of 57 muscles which lose their tone and mass as we age. We also often wind up training the muscles of our face to contract in a certain way which results in an undesirable breakdown of the dermal papillae between the dermis and epidermis - the classic "11" lines between the eyebrows are a great example of this. Cosmetic acupuncture treatments aim to address these issues of the muscles - triggering some muscles to re-engage, bringing tone back into the muscle resulting in a lifted appearance, and triggering other muscles to disengage - relaxing these muscles helps resolve and soften wrinkles.

The Takeaway
These four key components to healthy, effective anti-aging skin care are what make cosmetic acupuncture such an all-around successful treatment. Treating skin care holistically is 
of utmost importance, because the health of our skin is dependent upon the health of our entire body. Ignoring any one of these treatment strategies results in a less than desirable treatment, perhaps producing results, but with severe side effects and damage to the skin, or not producing results that are satisfactory to our patients.