Massage An Mo TUi Nas (massage chinois bien-être)

Le An Mo (traduit par massage chinois)

 
Bibiographie (de larges passages sont empruntés au livre suivant):
Chen Jun ” Tuina: théorie et pratique”, Presses universitaires Guang Ming
http://www.guangming.ch/terre.htm

Le An Mo( ou Tui An) fait partie intégrante de la médecine chinoise.

Rappelons les différentes disciplines de la médecine chinoise:
– acupuncture
– acupressure (pression digitale ou avec l’éminence thénar) des points d’acupuncture se trouvant sur les méridiens ou canaux transportant énergie et sang dans le corps.
– Tui Nas (traduit improprement par “massages” chinois)
– phytothérapie
– moxibustion
– utilisation des ventouses ( en bambou) ou en verre (pression à chaud ou à froid).
– nutrition suivant la médecine chinoise.

Tui et Na signifient: pousser, pincer, saisir les muscles.
An et Mo: appuyer, presser (An) et frotter
Tui et An: pousser, appuyer et presser.

Tui nas est traduit de façon générale par massage chinois.
Il a pour base les théories de la médecine chinoise.
Le ou la masseuse utilise ses mains (tout ou partie) ou coude par exemple en exerçant des mouvements spécifiques (sur des surfaces corporelles) afin de prévenir ou soulager des maux.
Ses applications sont nombreuses.

En chine, on désigne différents massages comme:
– Zheng Gu anmo: remise en place des os (maladies osseuses)
– Shangke Anmo: massage traumatologique (lésion des tissus mous)
– Xiao er Tui nas (petit massage): pour les enfants (xiao = petit, er = enfant, fils)
– Jingluo anmo: massage des méridiens et des collatéraux LUO
– zangfu anmo: massage des organes et des entrailles
-Shisi jing anmo: massage des 14 méridiens
– Jing Wai qi xue anmo: massage des points des méridiens extraordinaires
– Bao jian anmo est le massage de l’entretien de la santé
– Wushu anmo: massage basé sur l’entaînement interne des arts martiaux
– massage d’urgence JiJiu anmo
etc…

Dans notre pratique quotidienne en France nous sommes appelés à pratiquer le Bao Jian Anmo(entretien de la santé).
Dans d’autres pays plus au fait, nous sommes appelés à pratiquer les autres méthodes de Tui Nas.
Il est à noter que le terme de “massage” est mal usité mais employé par commodité car le Tui nasse distingue complètement dans sa pratique et dans ses objectifs des pratiques de massage kinésithérapeutique (ou de physiothérapie) ou de rééducation.

Un d’histoire…
Le Tui nas est sans doute la pratique thérapeutique la plus répandue et la plus ancienne dans l’histoire de l’humanité.
Tout le monde se masse dès que la douleur ou le froid se fait sentir.
Sans doute les premiers gestes du tui nas ont été le fait de personnes souffrant de douleurs suites aux combats (blessures d’origines externes) ou aux travaux physiques (origine externe) ou problèmes internes (émotions etc..)
Certains livres médicaux vieux de 2000 ans parlaient déjà du Tui Nas.
Le premier livre entièrement consacré au Tui Nas est le “Huang Di Qi Bo An Mo”, aujourd’hui introuvable.
Rappelez-vous du Huang Di Nei Jing, le premier livre médical chinois, aujourd’hui encore référence pour les praticiens…
Ce livre paru entre -221 à -207 est le premier livre qui explicite totalement la théorie de la médecine chinoise.
C’est un livre précieux que tout étudiant et tout praticien devrait avoir comme livre de chevet.
Durant la dynastie Qin et Han (-221 à 220), la technique du massage cardiaque étant connue et employée.
Pendant les dynasties Sui (580 à 618) et Tang (618 à 907), le massage Tui Nas devint une discipline à part entière.
Ainsi le Tui Nas était utilisé pour les maladies d’origine traumatique (lésions des tissus mous et fracture osseuse).
Utilisé par adjonction dans des champs disciplinaires de la médecine chinoise comme la médecine externe, interne, la pédiatrie.
Le Tui Nas était très répandu dans le peuple afin de prévenir les maladies et entretenir la “vie”.
L’auto massage était très développé (nous commençons seulement à nous intéresser en Occident).
Des onguents étaient utilisés suivant ce qu’il y avait à faire.

A partir de la dynastie Tang, le Tui nas a été employé couramment dans toutes les disciplines de la médecine chinoise.

A partir de la dynastie Ming (1368 à 1644), le Tui nas était un département spécifique de l’hôpital impérial.
C’est à cette époque que s’est développé le massage pour enfants, découvert directement par les effets du massage sur les convulsions infantiles.
Ce massage emploie des points et des lignes, considérant que les méridiens des jeunes enfants ne sont pas encore à maturité.
C’est un Tui Nas spécifique qui diffère du massage Tui Nas pour adultes.

De la fin de la dynastie Qing jusqu’en 1949, la médecine chinoise a été presque abandonnée par les gouvernements.
C’est grâce au peuple qu’elle a pu continuer à survivre et cela a donné des écoles et des styles de massages Tui Nas différents suivant les provinces à cause du manque de communication de ce si grand territoire.
Le massage Tui nas a également subi l’influence de la médecine Occidentale notamment avec les connaissances d’anatomie et de physiologie.
Les chinois sont beaucoup tolérants que nous face aux médecines venues d’ailleurs.
Ils ne prétendent pas avoir la seule science ou connaissance mais appliquent ce qui marche en fonction de l’intérêt de la personne qu’ils ont en face d’eux…

A suivre…

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Feasibility Study of Acupuncture for Reducing Sleep Disturbances and Hot Flashes in Post-Menopausal Breast Cancer Survivors

Clin Nurse Spec. Author manuscript; available in PMC 2012 September 1.
Published in final edited form as:
PMCID: PMC3292187
NIHMSID: NIHMS31
Julie L. Otte, PhD, RN, Assistant Professor,corresponding author Janet S. Carpenter, PhD, RN, FAAN, Professor, Xin Zhong, MSN, RN, and Peter A. S. Johnstone, M.D., FACR
The publisher’s final edited version of this article is available at Clin Nurse Spec
See other articles in PMC that cite the published article.

Abstract

Objectives

This was a feasibility study of a tailored acupuncture intervention in post-menopausal breast cancer survivors (BCS) reporting sleep disturbances and hot flashes. Objectives were: 1) to describe patterns of acupuncture point use, 2) evaluate outcome expectancy, credibility, and acceptability relative to the intervention; and 3) evaluate patterns of symptom change over time.

Design

Single group, non-randomized, quasi-experimental 8-week study.

Sample/Setting

Ten BCS with both sleep disturbances and hot flashes were referred to any of 4 Midwestern community acupuncturists.

Methods

Assessments were done at baseline (weeks 1, 2), during treatment (weeks 3, 4), and after treatment (week 5, 8). Acupuncture treatment was tailored to the individual by community acupuncturists and provided as 3 sessions within a 2 week period (weeks 3, 4). Patients wore a wrist actigraph during weeks 1, 2, 3, 4, 5, and 8 and a sternal skin conductance monitor for 24 consecutive hours during weeks 1, 2, 3, 4, 5, and 8. Subjective data were obtained by questionnaire at weeks 1, 2, 3, 4, 5 and 8.

Findings

Women were a mean age of 53, with an average 6.75 years since diagnosis. A mean of 10 needles were used per session with the most common points located in the LU or lung meridian. BCS had high expectancy that acupuncture would decrease their symptoms, believed it was a credible treatment and felt it an acceptable form of treatment. Three significant patterns of symptom change were noted from baseline: an increase in the number of minutes it took to fall asleep after treatment (from week 5 to 8, (p=.04); a decrease in the percentage of time awake after sleep onset from baseline to follow-up 2 (week 8) (p=0.05); and a decrease in number of hot flashes from baseline to follow-up 1 (week 5) (p=0.02).

Implications for Nursing

Findings may be used by Clinical Nurse Specialists to consider recommending acupuncture to improve sleep and reduce hot flashes in BCS.

Conclusions

Acupuncture treatment seems to be a feasible treatment option for highly motivated BCS with sleep disturbances and hot flashes but needs to be further evaluated in a larger randomized-controlled clinical trial.

Introduction and Background

Breast cancer survivors (BCS) represent the largest cancer survivor group in the United States, and the number is growing.1 Up to 65% of BCS experience menopausal symptoms such as sleep disturbances and hot flashes after treatment for breast cancer, with symptoms extending well over 5 years after diagnosis.2,3 These symptoms can be due to estrogen withdrawal resulting from natural menopause, abrupt withdrawal of hormone therapy at time of diagnosis, chemotherapy-induced ovarian dysfunction, and/or long-term treatment with estrogen ablation therapies. Even if women are post-menopausal (cessation of menstrual cycle for 12 months or more) prior to diagnosis, symptoms can often reoccur as a result of cancer treatment. These symptoms have been reported to negatively affect health-related quality of life in BCS.4

Sleep disturbances and hot flashes are menopausal symptoms that continue to be research priorities at the national level. Sleep disturbances are physiological, psychological, environmental, or behavioral nighttime disruptions that have an impact on daytime functioning and are defined as perceived or actual disruptions in nighttime sleep or daytime wakefulness. For BCS, the most common sleep disturbance is chronic insomnia, in which women have a hard time falling asleep and staying asleep. Hot flashes are a sudden sensation of heat over the face, neck, and chest, and may be accompanied by patches of flushed skin. Patients may experience sudden drenching perspiration with or without shivering.5 Hot flashes are frequently quite debilitating, and the best therapy (hormone therapy) is contraindicated in BCS. 6

Although these are common problems in BCS, there are few known effective interventions. Women are often offered separate pharmacological interventions for each symptom, and these typically have only minimal positive effects and often undesirable side effects. For example, medications for sleep disturbance in cancer patients have yielded variable results.7,8 Several trials of hot flash treatments such megestrol acetate, 6 clonidine,9,10 methyldopa,11 bellergal,12 venlafaxine,12,13 gabapentin,14 Vitamin E,15 soy,16 and black cohosh17 have shown minimal success. Thus, these symptoms are exceptionally fertile areas for study using nontraditional therapies.

One non-traditional therapy receiving attention in the cancer and non-cancer research literature is acupuncture. It has been tested in several small cancer-related studies1826 and a few randomized-controlled, non-cancer studies, with varying results possibly related to differences in subjective hot flash measurement and acupuncture technique.2736 After the National Institutes of Health Consensus Conference on acupuncture,37 there were several positive prospective trials38,39 of acupuncture for relief of various symptoms such as adult postoperative- and chemotherapy-related nausea and vomiting, postoperative dental pain, and sleep disturbances.

The theoretical framework for this study is based on Traditional Chinese Medicine (TCM), defined as a holistic system of health and healing grounded in the notions of balance, harmony, moderation, and prevention.40 TCM recognizes several causes for hot flashes (e.g., excessive Heart Fire or depleted Kidney Water). We have previously documented that hot flashes of either menopausal or iatrogenic etiology may be diagnosed as Kidney Water Exhausted.41 For this unfamiliar Eastern diagnosis, there are any number of internally logical acupuncture points and treatment regimens prescribed by acupuncturists. These are determined by TCM physical examination of the pulse and the tongue. 42Similarly, sleep disturbance is associated with particular causes, generally related to a Yin vacuity. When associated with hot flashes this portends chong and ren dysregulation.43

The involvement of several different community-licensed acupuncturists was a unique factor in this trial, since most published acupuncture data have been from academic practices; community-licensed acupuncturists traditionally have not been widely involved in academic acupuncture. This is in contrast to standard acupuncture practice in which community-licensed acupuncturists treat virtually all patients.

The purpose of this study was to evaluate the feasibility of acupuncture as a treatment for concurrent complaints of sleep disturbances and hot flashes in BCS. The objectives were: 1) to report patterns ofacupuncture point use; 2) evaluate outcome expectancy, credibility, and acceptability relative to the intervention; and 3) evaluate patterns of symptom change over time.

Patients

The study was approved by the institutional review board. Forty-five BCS were screened for treatment for sleep disturbances and hot flashes during a 12-month period. Of those screened for the study, 8 were self-referrals responding to a mailing and 37 from physician clinic referrals. 35 of the 45women screen were not eligible or interested for the following reasons; (1) lived to far from the university for weekly visits (n=10), (2) did not have sleep disturbances and hot flashes (n=4), (3) were not 3 months post-treatment (n=3), (4) had prior acupuncture treatment (n=3), (5) had a current psychiatric disorder (n=3), (6) were not post-menopausal (n= 1), (7) did not want treatment for sleep and/or hot flashes (n=1), (8) were too busy to commit to the 8 weekly visits (n=9), and (9) was participating in another clinical trial (n=1). 10 BCS consented to the study.

Women were eligible if they (1) were least 18 years of age, (2) reported sleep disturbances over the past month, (3) reported daily hot flashes and frequent sleep disturbances with desire for treatment, (4) were peri- or post-menopausal, (5) agreed not to change sleep or hot flash medication use or dosages during the course of this study, (6) lived within a 100-mile radius of the study site, (7) were English-speaking, (8) had a known diagnosis of non-metastatic breast cancer and no history of other cancers, and (9) were at least 3 months post-completion of surgery, radiation, and/or chemotherapy. Women were excluded if (1) they had known psychiatric or cognitive disorders, (2) had a prior personal history of acupuncture use, or (3) were participating in other clinical trials.

Design

The study used a single group, non-randomized, quasi-experimental design.

This was an 8-week study (see Table 1). Each subject selected one of four participating certified community acupuncture providers for three acupuncture treatments over a 2-week period. Demographic and disease and treatment questionnaires were administered during the first week of the baseline assessment. Outcome expectancy and credibility were assessed after the first treatment had been completed (treatment week 1) and acceptability at the first follow-up visit. Physiologic monitoring using wrist actigraphy and hot flash monitoring occurred for 2 weeks prior to acupuncture as a determinant of baseline, as well as during the 2 weeks of acupuncture, and during two follow-up weeks (weeks 5, 8 of study). Additionally, self-reported symptom data were obtained using validated questionnaires at baseline, during treatment, and during each follow-up week.

Table 1

Study Schema

Acupuncture sessions

The optimal acupuncture point regimen is unknown for either sleep disturbances or hot flashes. Acupuncture points used during treatment were dependent on the individual subjects’ TCM diagnoses as determined by the licensed acupuncturists. However, each of the contracted licensed acupuncturists agreed to use the same tailored treatment regimen for all three treatments for each individual subject. The protocol gave subjects the option to have treatments from one of four licensed acupuncturists who were located at two separate clinics and held a National Certification Commission for Acupuncture and Oriental Medicine certification and who provided appropriate therapy based on their experience and Traditional Chinese Medicine (TCM) diagnosis. All of the acupuncturists were Caucasian-American, had at least 6 years of patient experience (M=11.33, SD=8.39), had a master’s degree in Oriental Medicine from an accredited American school, and were members of the local and national professional organization for acupuncturists. None of the acupuncturists practiced under a different health care role such as nursing,

Measures

Measures are described below. Monitoring using wrist actigraphy and sternal skin conductance was performed as described below. Each of these devices required that data be downloaded every 7 days. Women were required to visit the onsite clinic each week to return study materials and have their monitors programmed for the subsequent week. Data were downloaded by trained study staff and stored in a secure, encrypted database in de-identified format on a secure server.

Demographic Questionnaire

A standard questionnaire previously used in research studies was used to record basic demographic and health information including age, race, ethnicity, marital status, employment status, socio-economic status, education, menopausal status, medication, height, weight, and number and type of co-morbid conditions. Medical comorbidity was assessed using a standardized checklist of categories of common medical disorders.44 Frequencies were reported for individual co-morbid conditions.

Disease and treatment information

Disease and treatment information was abstracted from medical records. Information included date of diagnosis, stage of disease, and dates and types of treatments including surgery, chemotherapy, radiation, selective estrogen receptor modulators, and aromatase inhibitors.

Acupuncture session

The subject TCM assessments and acupuncture were recorded on lined treatment notes by each acupuncturist. These forms were not standardized questionnaires but open- ended notes commonly used in TCM evaluations. Details included the specific meridian point, location (left side, right side, both sides) of point placement, and side effects/tolerance of treatment session.

Outcome expectancy-credibility and acceptability of treatment

The 6-item Devilly and Borkovec Outcome Expectancy/Credibility Questionnaire was used to assess outcome expectancy and treatment credibility at the on-treatment assessment.60 Three questions assess outcome expectancy and three assess treatment credibility. For outcome expectancy items participants are asked to indicate how much they think treatment will help improve symptoms using a 0% to 100% scale, how much they feel treatment helped improve symptoms using a 0% to 100% scale, and how much they feel treatment reduced symptoms using response options from 1 (not at all) to 5 (somewhat) to 9 (very much). For treatment credibility items, participants are asked to indicate how logical the treatment was, how successfully they think treatment reduced their symptoms, and how confident they are in recommending the treatment to a friend. Each question for treatment credibility is rated on a 1 to 9 scale. Responses to items on each subscale are standardized and summed to create a total subscale score. Higher scores indicate greater belief that the treatment would provide beneficial results (outcome expectancy) or greater belief in the credibility of the treatment (credibility). In studies of men and women, for expectancy Cronbach’s alphas were .79 to .90 and one-week test-retest reliability was r=.82 (p < .001). Cronbach’s alphas for credibility ranged from .81 to .86 with one-week test-retest reliability of r=.75 (p<.001).60 For this study, Cronbach’s alpha was 0.67 for the outcome expectancy subscale and .96 for the treatment credibility subscale.

The Acceptability Scale was administered at weeks 4 and 8 of follow-up. It is a 10-item investigator-designed questionnaire that contains 10 items taken from a questionnaire used in a prior study evaluating hot flash interventions.59 Women are asked to read each of 10 statements and choose a response ranging from 5 (strongly agree) to 1 (strongly disagree) with 3 being neutral. For example, women rated their level of agreement or disagreement with statements such as “I enjoyed the acupuncture sessions” (see Table 3). Frequencies of individual item responses were reported in the analysis of this study; a total score was not calculated. Since frequency of individual items are reported psychometrics were not appropriate for this questionnaire.

Table 3

Acceptability Scale Results

Wrist actigraphy

Sleep was assessed using the Actiwatch® (Mini Mitter, Bend, OR) device. The wrist Actiwatch® contains an accelerometer that measures sleep and wake activity through motion of the wrist. The device is worn on the non-dominant wrist and resembles a regular wristwatch. The unit measures 1” × 1” × 0.25” and weighs 0.75 ounces. At the end of each recording session, the device is downloaded into a personal computer and customized software is used to quantify sleep efficiency calculated as a percentage [time spent asleep/time in bed] x 100) and total rest in minutes calculated as total number of minutes asleep ([minutes of day naps + minutes of night sleep] – minutes awake after sleep onset). This measure has been widely used among cancer patients as a valid, objective measure of sleep. 13,45 Although wrist actigraphy is not as accurate as polysomnography, the gold standard for measurement of sleep onset, sleep latency (the number of minutes it takes to fall asleep once in bed), number of nighttime awakenings, and total sleep time,46 actigraphy is more accurate than self-completed sleep logs.47

Sleep diary

A 7- night sleep diary was completed by participants to facilitate wrist actigraph data analysis. This record measures time to bed, time out of bed, and naps. Information was entered into the Actiwatch® software for interruption of total sleep time (TST), wakefulness after sleep onset (WASO), sleep efficiency (ratio of time spent asleep to total time in bed), and number of nighttime awakenings.

Subjective sleep quality and disturbance

The Pittsburgh Sleep Quality Index (PSQI) measures sleep quality and disturbance retrospectively over the previous two weeks or month using self-report.48,49The PSQI consists of 19 items that produce a global sleep quality score as well as the following seven component scores: sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbance, use of sleeping medications, and daytime dysfunction. Global sleep scores greater than 5 are considered to indicate poor sleepers. The items use varying response categories including Likert-type responses (0=not in the past month to 3=3 or more times per week). A sample item is, How often in the past month did you wake up and have to use the bathroom? Psychometric properties of the PSQI such as internal consistency reliability have been widely supported in a variety of populations5052 including BCS (n=102; α=0.80.)53

Sternal Skin Conductance Monitoring

Physiological hot flash frequency was assessed using sternal skin conductance monitoring Biolog® model 3991 (UFI, Morro Bay, CA).54 The Biolog® is powered by a standard 9-volt battery and is programmed to sample 12-bit skin conductance data at 1 Hz (once per second). It is placed in a bag and worn around the waist or across the shoulders. An event marker on the monitor can be depressed by participants to signal the subjective perception of a hot flash. This event marker timestamps the sternal skin conductance data and was used to help interpret the skin conductance data during data analysis. At the end of each monitoring session, the monitor is connected to a personal computer through the Biolog Interface Box® (UFI, Morro Bay, CA) and data can be downloaded. Sternal skin conductance monitoring is more specific to detecting hot flashes than measures of core or peripheral temperature,55 and it is highly correlated with self-reported hot flashes under controlled conditions.56 Laboratory studies indicate 95% to 98% of subjective hot flashes correspond to objective hot flashes among midlife women.56,57

Perceived hot flash interference

The Hot Flash Related Daily Interference Scale (HFRDIS) is a 10-item scale measuring the degree to which hot flashes interfere with nine daily activities as well as overall quality of life using Likert-type responses (0=does not interfere to 10=completely interferes).58 For example, women rate how hot flashes interfere with work, social life, and mood. Psychometric analysis supports validity and reliability of the HFRDIS for use with BCS (n= 69 BCS; Cronbach’s alpha=0.96), with strong correlations with other hot flash variables and demonstrated sensitivity to change over time.58

Statistical Analysis

Due to the feasibility nature of this study, we planned to accrue 12 subjects to generate hypotheses for further study. According to Julious,61 12 subjects is roughly the minimum sample size needed for a pilot study using continuous outcomes (e.g., number of hot flashes and sleep disturbance measures).

Demographic and breast cancer treatment information was analyzed with descriptive statistics and frequencies using SPSS 17.0 (Chicago, IL). Questionnaires and objective measures were evaluated for missing data points. There were no missing questionnaire data. The two baseline assessments were averaged for all outcome variables to facilitate statistical analyses.

Because of the number and complexity of acupuncture points used for treatments, descriptive statistics were used to determine the mean number of points administered per treatment per participant and reported side effects. Frequencies were used to determine the number of different acupuncture points and placement location. Paired t tests were used to determine if the mean number of acupuncture points received per treatment per participant changed over time. The data was reviewed and the assumptions of paired t tests were met. Alpha was set at p<0.05 for all analyses. With conducting multiple t tests, the overall probability of a Type I error is typically > 5%. The authors’ note that this inherent risk for a Type I error did not justify an adjustment in alpha given the exploratory nature of study, limited power due to the small sample size, and need for confirmation in future studies. This should be considered by the reader when interpreting the findings of the study.

Descriptive statistics and frequencies were used to evaluate outcome expectancy, treatment credibility, and acceptability of treatment. Chi square tests of independence were used to compare individual treatment acceptability questionnaire responses between the two follow-up time points.

Descriptive statistics were used to report mean global sleep and mean hot flash interference scores over time. For objective measures, sleep disturbances were evaluated using the average of common sleep variables: 1) wake after sleep onset (WASO) in minutes, 2) total sleep time (TST) in minutes, 3) sleep efficiency (range from 0% to 100%), and 4) number of nighttime awakenings. Due to missing data for sleep monitoring, three consecutive days were used for analysis. The 3-day time frame could not include the first day of recording and had to have all hours of the day represented with a complete sleep log. Averages were then calculated based on the software output with additional visual inspection to ensure accuracy. Physiologic hot flash frequency was calculated as the total number of hot flashes per 24-hour day.

Lastly, to determine patterns of change in sleep disturbances and hot flashes across the 8 time points, continuous outcome variables were evaluated using paired t tests (SPSS 17.0). This test was selected since it is more powerful than other non-parametric tests for small sample sizes.

Results

Subjects

Ten women were enrolled to participate in the 8-week study. Of the 10 BCS that completed baseline, 2 withdrew after the last baseline assessment due to time commitments that prohibited them from completing weekly study visits. The remaining 8 BCS completed all time points. The BCS averaged 53 years (SD=10.07), all were Caucasian (100%), and most were college educated (63%), married or partnered (88%), working full or part-time (88%), and not Hispanic or Latino (88%). The majority (63%) did not have non-cancer related co-morbidities. Mean time from diagnosis was 6.75 years (SD=2.60), and mean body mass index was 23.32 (SD=4.37). Most had stage 0–1 breast cancer (57%) and all had received some type of cancer treatment such as surgery, chemotherapy, or radiotherapy (100%). The majority of BCS were not taking a hormone modulator at the time of this study (38%).

Patterns of acupuncture point use

A total of 38 different acupoints was used for treatment. The mean number of treatment points administered per subject per treatment was not significantly different among the three treatments (t= −0.42 to −0.55; p=0.60–0.69) or among the four different therapists. The majority of treatment points were located on the Lu (lung) meridian. The second and third most common points were the Sp (spleen) and Li (large intestine) meridians. Lastly, Ki (kidney), HT (heart), and Ren vessel meridians had similar patterns of usage. The most common acupoints used are listed in Table 2. The location and number of acupuncture points per participant remained constant over the 3 treatments (treatment 1- M=10.13, SD=2.03; treatment 2- M=10.50; SD=2.93; treatment 3- M=10.38, SD=2.39). There were no reported side effects for any subjects. The sessions were mainly conducted at one clinic (n=6).

Table 2

Description of Most Commonly Used Acupuncture points

Outcome expectancy, credibility, and acceptability of treatment

BCS reported high outcome expectancy, that is, they believed that acupuncture would help improve their symptoms (M=21.37, SD=4.07). BCS also rated that acupuncture treatment as having high credibility (M=21.00, SD=3.42). BCS reported that acupuncture was acceptable and helped with symptoms of sleep disturbances and hot flashes, and that the sessions were enjoyable, not painful, and comfortable (Table 3). Women did not think the treatment sessions took too much time out of the day. They found it easy to make treatment appointments, stated that the acupuncturists seemed to want to help diminish symptoms, and would not have preferred to have a different acupuncturist perform the treatments. Overall, the women would recommend acupuncture to a friend and would not have preferred a different treatment to help with symptoms.

Patterns of symptom change

As shown in Table 4, at baseline women reported poor global sleep scores (M=9.25, SD=4.10) and, as objectively measured, had less than the recommended total sleep time of 7–9 hours of sleep per night62(M=6.84, SD=0.73), took almost 18 minutes to fall asleep, and experienced nearly 47 minutes of wakefulness after sleep onset. The average number of nighttime awakenings was 32 (SD=10.22), with an average sleep efficiency of 83%. The mean number of objective hot flashes was 12.58 (SD=13.41) per 24 hours, and on average hot flash daily interference was mild (M=3.60, SD=2.69).

Table 4

Patterns of Symptom Change Over Time

Three significant patterns of symptom change were noted. First, average sleep latency significantly increased after the acupuncture treatment stopped from study week 4 to week 8 (t=−2.57, p=0.04). Second, although marginally significant, there was a decrease in time spent awake after sleep onset from baseline to time 8 (t=2.53, p=0.05). Lastly, the average number of hot flashes recorded by the sternal monitor significantly decreased from baseline to time 4 (t=2.95, p=0.02). No other significant changes over time were found (Table 4).

Discussion

The novel mechanism of letting several different acupuncturists provide therapy based on their particular experience and diagnoses has not been previously studied in BCS with both symptoms of sleep disturbances and hot flashes. Previous research typically used set acupuncture points with no deviation allowed. This practice is not in line with the traditional use of acupuncture, which prescribes a more individualized or tailored approach to treatment.

Expectancy, creditability, and acceptability of treatment were high. The acceptability responses were comparable to a previous behavioral intervention for hot flashes in BCS.64 Individual responses on five items for the acceptability scale improved from week 4 to week 8 of the follow-up assessment. This suggests that select, highly-motivated BCS were willing to undergo this type of treatment for sleep disturbances and hot flashes, supporting the feasibility of future studies.

Acupuncture has the potential to improve problems with sleep and hot flashes over time. However, the significant increase in sleep latency from week 4 to week 8 indicates that in this study, after acupuncture was completed there was some loss of treatment benefit. This suggests that short-term acupuncture treatment may provide immediate but not long-term benefits for sleep latency (number of minutes to fall asleep at night) since this increased or got worse at week 8 compared to baseline. On the other hand, the significant decrease in wake after sleep onset from baseline to week 8 suggests there was a sustained effect of acupuncture over time for this variable. These results are comparable to non-cancer studies using acupuncture for insomnia that found significant increases in self-reported hours of sleep, sleep efficiency, and ability to fall asleep and stay asleep.27,30,31 Last, the significant decrease in hot flashes from baseline to week 4 reflects an immediate treatment effect for this variable, but the benefit of acupuncture for hot flashes was short-term. Although there were fewer baseline objective hot flashes in this study compared to a cognitive behavioral intervention for hot flashes in BCS,64 there was a more significant change over time using acupuncture compared to the cognitive intervention.64 These are similar findings to non-cancer studies that have used acupuncture for hot flashes.23,35

Women entered the study with mild to moderate hot flash interference noted by mean scores less than 4 (total scores can range 0–10). This could be due to the small sample of BCS in this study. However, there was a non-significant downward trend from baseline to week 4 indicating slightly less hot flash interference over time. A larger sample could provide more variability in mean scores showing more treatment effect. Although perceptions of hot flash interference did not significantly change over time, a previous study showed that hot flash interference may be the most appropriate single measure to include in treatment studies.65 Measuring and improving patients’ perceptions of hot flashes’ interference with life activities and subjective sleep quality may be the most direct routes to improving quality of life. More acupuncture treatments may be needed to significantly decrease hot flash interference. Previous randomized, controlled, longitudinal studies have typically used treatment schemas with sessions occurring two or more times per week over 5–10 weeks.23,25

Limitations

There were several limitations of this study. First, the small sample size limited our ability to determine a meaningful effect size. Second, the number of treatments per subject was limited to 3 over 2 weeks, which is fewer than most acupuncture studies. Third, there is a need to assess treatment fidelity in a larger study. Fourth, the sessions were mainly conducted at one clinic with one acupuncturist limiting our understanding of treatment patterns. Finally, this was a homogeneous, highly-motivated sample of BCS therefore the generalizability of results is limited. These limitations should be considered when interpreting the findings of this study.

Implications for Clinical Nurse Specialists

The use of complementary therapy provides non-pharmacological treatment options for symptom management in cancer patients. Serving as patient advocates, Clinical Nurse Specialists (CNS) integrate existing evidence into clinical practice and provide cost-effective treatment for both inpatients and outpatients who have sleep disturbances and hot flashes. One study showed that nurses’ personal knowledge, experience, and attitudes relative to complementary therapy can influence their use of such treatments in critically ill patients.66 Communication between nurses and other caregivers is important to ensure the appropriate use of acupuncture for symptom management. CNSs should work in tandem with acupuncturists by being sure the latter are informed at every point about relevant patient status variables so they can select the most appropriate points and length of treatment for individual patients. The CNS also needs to identify any barriers to this type of treatment in partnership with the patient, other health care providers, and family members but recognize that this might not be a desirable treatment option for all patients.67 The current study has added to our knowledge about the role of acupuncture as an option for highly motivated patients seeking symptom management and suggests how the CNS could conduct future studies.

Future research

Our goal is to build on these study results by conducting a large-scale randomized controlled clinical trial using a larger number of community acupuncturists. Future studies should allow the treating acupuncturists to continue to select appropriate points for the patient to provide a more holistic approach that adheres to the traditional Chinese approach to treatment. Studies should 1) continue to evaluate specific points used to determine patterns of effective treatment points, 2) use fewer assessment visits to reduce the need for weekly travel to the study site and possibly increase interest in participation, and 3) increase the number of treatment sessions to allow for possible greater treatment efficacy over time.

Acknowledgments

The authors would like to acknowledge support from statisticians Jingwei Wu and Michael Weaver; research nurses Jill Deluca and Kathy Tutor; licensed acupuncturists Mitch Harris, Erica Harris, Shane Haggard, and Jennifer Meador-Stone; and editor Phyllis Dexter.

Biographies

Dr. Julie L. Otte is an Assistant Professor at the Indiana University School of Nursing. She was a doctoral student and post-doctoral fellow at the time this project was implemented.

Dr. Janet S. Carpenter is a Professor in the Indiana University School of Nursing. She was an Associate Professor at Indiana University during this project.

Ms. Xin Zhong is a Clinical Nurse Researcher at the Indiana University School of Medicine. She was a master’s student at the time this project was implemented.

Dr. Peter A. S. Johnstone is a Professor at the Indiana University School of Medicine and Director of the Department of Radiation Oncology.

Footnotes

Disclosure of Funding: National Institutes of Health KL2 RR025760, National Cancer Institute R25 CA117865.

Contributor Information

Julie L. Otte, 1111 Middle Drive, NU 442 Indianapolis, IN 46202 Phone: 1-317-274-0886 Fax: 1-317-278-1856.

Janet S. Carpenter, 1111 Middle Drive, NU 423 Indianapolis, IN 46202 Phone: 1-317-278-6093 Fax: 1-317-278-1856.

Xin Zhong, 1111 Middle Drive Indianapolis, IN 46202.

Peter A. S. Johnstone, 535 Barnhill Drive RT 041 Indianapolis, IN 46202 Phone: 1-317-944-2524.

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Les bouffées de chaleur de la ménopause en médecine chinoise

Effets secondaires de la ménopause et Médecine Chinoise

 

La ménopause est un stade très important chez la femme tout comme la venue des premières règles.
Il convient de savoir accompagner ces différents stades.
La ménopause est l’arrêt des règles. 
Elle peut entraîner des effets secondaires plus ou moins gênants et perdurant dans le temps.
L’aspect culturel et personnel est également à prendre à compte: elle peut être vécue comme très invalidante et déprimante puisqu’elle signifie la fin de la possibilité d’enfanter.

Les effets désagréables de la ménopause comme les bouffées de chaleur, les transpirations diurnes et/ou nocturnes, l’irritabilité, les insomnies, la prise de poids, la mauvaise circulation sanguine peuvent être améliorés avec la Médecine Chinoise.
Tout comme les douleurs (articulaires, musculaires, tendineuses ou des viscères) c’est une des grandes indications de cette médecine.

Sans entrer dans les détails, il existe une combinaison de points très “populaires” à propos notamment des bouffées de chaleur et des sueurs conséquentes ainsi que des troubles de la ménopause en général.
Dès la première séance, la consultante doit ressentir les jours suivants, une amélioration notable. 
La médecine chinoise a les moyens de soulager durablement et radicalement:
– bouffées de chaleur 
– sueurs nocturnes et/ou diurnes
– insomnies
– troubles de l’humeur
– mauvaise circulation et gonflement
– prise de poids

Bien entendu, le praticien devra toujours veiller à proposer un ensemble de combinaison de points suivant le cas traité sinon ce sera du tout venant et cela dénature la médecine chinoise qui est une technique au cas par cas.

Les points d’acupuncture (même stimulés par pression digitale) sont efficaces mais il y a aussi la phytothérapie chinoise qui est remarquable.
 En particulier, en cas de bouffées de chaleur, transpirations nocturnes rebelles à tout traitement classique.
Si un traitement chimique est contre-indiqué après un cancer du sein, par exemple, la phytothérapie chinoise peut être remarquable.  
Toutes les plantes sont autorisées et contrôlées par l’ A.F.S.S.A.
Le praticien en MTC est à même de vous conseiller ce type de plantes, ne les prenez pas seule, vous risquerez de tomber à côté.

 



Quelques explications pour aller plus loin:
Le sang en médecine chinoise appartient au monde du Yin (la matière, le nutritif, la densité).
Le Yang régit toutes les activités du corps: réchauffement du corps, circulation des nutriments, système défensif etc…
Le sang-Yin a besoin du Yang pour circuler dans le corps et ne pas stagner. 
Le yang est comme une essence volatile, il a besoin du Yin qui est lourd et dense. Le Yin ancre la Yang et l’empêche de s’échapper.
A l’équilibre, ce qui correspondrait à l’état dans lequel l’être humain est en bonne santé, le Yin et le Yang sont pratiquement au même niveau.
Nous pouvons comparer le niveau de Yin et de Yang au niveau d’essence dans un moteur. 
L’arrêt des règles signifie moins de Yin [circulant dans le corps].
Cette baisse de Yin entraîne une montée (artificielle) de Yang parce que le Yang de par sa nature ascendante a déjà tendance à s’élever naturellement.
C’est pour cela que la femme a chaud à certains moments de la journée ou en fin de journée.
Donc nous veillerons à nourrir ce Yin-sang qui fait défaut tout en abaissant la chaleur (le Yang).
En aucun cas, on ne masque le problème: c’est en “nourrissant” le Yin que l’on constate des améliorations notables et qui perdurent dans le temps. 

Les organes entrailles sont décrits différemment dans leurs fonctions qu’en Médecine Occidentale. 
Ce qui faut retenir de cette vision c’est qu’il y a une logique et que cette logique conduit à la mise en place de soins adaptés suivant les cas.
Ainsi, les troubles de l’humeur constatés proviennent soit du coeur, soit du foie ou les deux.
Le coeur est le monarque du corps humain.
Le coeur est lié à la Joie (“avoir du coeur à l’ouvrage”, “écouter avec son coeur”). 
Il régit la circulation sanguine dans les vaisseaux (c’est une pompe à très forte impulsion).
C’est aussi celui qui régit les pensées, la conscience, les activités mentales, intellectuelles d’après la vision de la médecine chinoise.
Les médecins chinois connaissaient très bien l’anatomie; cependant ils ont classé le cerveau comme “entraille curieuse” relié aux Reins.
Les sueurs sont le liquide du coeur.
Cette déficience de Yin-sang peut affecter le coeur et provoquer soit des sueurs soit des insomnies soit de l’irritabilité ou tout cela combiné. 
Le Foie régule les besoins du sang de l’organisme.
Il gère la libre circulation énergétique du corps, un peu comme un garde barrière qui ouvre et ferme la porte suivant les besoins. 
Le foie est lié à la colère, aux frustrations, rancoeurs.
Certaines femmes peuvent ressentir la perte des règles très négativement en particulier si le désir d’enfant n’a pu être réalisé (du tout ou encore une fois).
D’autres, au contraire, ne ressentent rien de spécial.
De plus moins de sang circulant peut avoir un impact négatif sur le Foie: l’énergie sera coincée, la personne aura parfois tendance à s’énerver facilement, avoir des douleurs inter costales… 

Enfin la rate produit le sang à partir des céréales et des boissons (bol alimentaire).
La rate avec l’estomac est une usine de raffinement des boissons et des aliments.
Elle produit les nutriments dont le corps a besoin. 
La femme est toujours en vide de la rate du fait qu’elle produit les règles.
Donc la rate peut être affectée par un ralentissement naturel du à l’âge.
Lorsque la rate raffine moins bien les aliments, elle produit du “Tan” qui se traduit par des gonflements le plus souvent abdominaux et parfois de la prise de poids.
Les reins sont également un support du sang. Les reins correspondent aux os en médecine chinoise.
A partir de 35 ans chez la femme, c’est un élément à toujours vérifier notamment par la prise des pouls chinois.
Donc si nous tonifions les reins, nous aurons un impact positif sur les os.




Essais cliniques confirmant l’efficacité de l’acupuncture et de la médecine chinoise:
Des essais cliniques ont montré la pertinence de l’utilisation de ces techniques dans les bouffées de chaleur, les insomnies, l’irritabilité…
La médecine chinoise a 3000 ans de clinique pratique.

Les hormones synthétiques ayant montré leurs limites et leurs restrictions pour certains cas, il serait sans doute sage d’aller se renseigner pour savoir quelle genre de médecine douce peut vous aider.
Citons également l’homéopathie (la sauge) qui a également des effets notables pour ce type de problème.

Pour moi, le succès de ces essais cliniques montre bien que la médecine chinoise soit par acupuncture soit par acupressure soit par la phytothérapie a une action réelle sur le système hormonal sinon comment cela serait-il possible?

Cancer du sein et médecine chinoise en traitement complémentaire:
Parmi les personnes atteintes d’un cancer du sein en rémission, il est intéressant de pouvoir associer la médecine chinoise à un traitement médicamenteux chimique qui peut occasionner des bouffées de chaleur par exemple, des tensions mammaires, des douleurs articulaires, une dépression…

Enfin, je tiens à souligner que cette période est souvent pénible pour les consultantes car elles ont l’impression de ne plus maîtriser leur corps: parfois des séances de relaxation en compléments sont les bienvenues.
Une écoute bienveillante et attentive de la part du praticien est également précieuse.
Tout comme les douleurs des règles, longtemps reléguées aux “simagrées de bonne femme” c’est un stade délicat pour certaines. 

Sources: sur le site gouvernemental pubmed line (textes en anglais)
http://www.ncbi.nlm.nih.gov/pubmed/22314633 (acupuncture et phytothérapie chinoise vs hormonothérapie)
http://www.ncbi.nlm.nih.gov/pubmed/22366695 (cancer du sein et médecine chinoise)
http://www.ncbi.nlm.nih.gov/pubmed/22281311 (cancer et MTC)

In TCM, I trust.
Copyright Alice Tamaccio pour toutsurlamedecinechinois.blogspot.com décembre 2012 


Alice Tamaccio, praticienne en médecine traditionnelle chinoise depuis 2006.
Diplômée IMTC & Certificat des Universités de shanghai et pékin
Aix en provence  06 22 19 38 91 délivrance facture sous demande
Genève                079 950 6847 Remboursée par les assurances complémentaires Suisses

Back pain and Traditional Chinese Medecine

Image

My back is painful…

What can I do?

TCM can be an effective way to resolve back pains.

After asking some questions about your life habits

The praticioner observe your tongue and make chinese pulse palpation

What’s for?

He collects informations to make a correct chinese diagnosis which is completely different from western medecine

And ????

With all these informations

He chooses the right combinaison of acupuncture points.

By stimulating these points vitality of the body is greatly improved

Finally painful zones are relaxed

Does it last?

In many cases yes

But may be you have to adopt a healthy lifestyle and the TCM praticionner can help you!

See More…

http://www.youtube.com/watch?v=UTr4rTrOf7w

Traditional Chinese Medecine in Aix en Provence

TCM is a great value for your health!

If you are interested by natural way of recovery

If you want to improve your health and your wellness

If you want to understand why you fall ill

If you think health is a mix between mind and body

If you are fascinated by oriental global vision of human body

You are ready to experience TCM!

For 3000 years in Asia TCM has been used as a complete care system…

See more: