Tinnitus Eastern vs Western Medicine

Tinnitus From Western View

Tinnitus is the medical term for ringing in the ears and according to Western medicine, it is not a disease but a symptom of several health conditions that produce sounds that fill a person's head with noise that only they can hear. The phantom sounds snap, crackle, pop, ring, hiss, roar, hum, whistle, click and squeal. The quality can be pulsating, intermittent, or steady and may vary in pitch. People with severe tinnitus may have difficulty with sleep, focus, and concentration leading to irritability, depression, increased stress and anxiety. Milder symptoms may go unnoticed. Three months or longer is considered chronic. One study links poor alignment of the skull and jaw to tinnitus. A person experiencing symptoms may be referred to an audiologist, otolaryngologist (ENT), dentist, neurologist, physical therapist, chiropractor, or massage therapist.

Adults and children can get tinnitus, but it is most common in adults age 40 and 80. 

A common cause of tinnitus is damage to the inner ear hair cells, which convert sound waves into electrical impulses that are carried along the auditory nerve to the brain. If the hairs are bent, they can leak random impulses to the brain, creating a cacophony of internal sounds. Many genetic and environmental factors, such as overexposure to loud noises and aging, destroy critical cells in the hearing system. 

Impacted ear wax, bacterial infection, head injuries, TMJ, vertigo, Meniere's disease, acoustic neuroma, hypertension, atherosclerosis, surgery, circulation problems, age, trauma, and vestibular tumors are associated with tinnitus. 

Over 200 medications contribute to tinnitus symptoms. Examples include diuretics, aspirin, NSAIDS, anticonvulsants, antibiotics, antimicrobials, loop diuretics, antidepressants, and cancer drugs. 

Tinnitus treatment in Western culture might include a white noise machine to mask the sounds, cognitive behavioral therapy, wearing hearing aids, antidepressants, anti-anxiety medications, counseling, relaxation techniques, and retraining therapy.

Lifestyle changes to alleviate symptoms of tinnitus include limiting caffeine and alcohol, avoidance of noisy environments, and cessation of smoking.

Tinnitus Eastern View

In TCM, the imbalance of Yin and Yang is the main cause of tinnitus. For many people, tinnitus expresses a deeper disharmony that has grown over time. Chinese medicine nourishes the body by addressing the underlying imbalance (the root) rather than the symptom (the arm). Digestion, mood, and emotion are also considered when treating tinnitus with Eastern medicine. 

Some of the more common patterns of tinnitus in Chinese medicine are as follows:

Imbalance of liver-spleen vertigo and tinnitus presents with liver symptoms, cricket sounds, vertigo or dizziness, and a heavy head. Chronic deficiency of spleen qi can lead to internal dampness. When dampness is combined with stagnated liver Qi it causes an upward rise of phlegm-fire. 

The kidney-liver imbalance is due to chronic stagnating liver qi is usually caused by stagnation and Yin Deficiency in the liver and blood.

Vertigo and tinnitus due to liver excess is typically triggered by loud noises which cause an upward rise of liver fire that may be related to frustration or anger. This internal wind is usually accompanied by dizziness and a painful sharp, stabbing headache.

Tinnitus with Imbalances in kidneys and heart involves the elements of water and fire, which must be balanced to preserve wellness and health. When one or both of the two energetic organ systems is compromised, a communication breakdown can arise. Kidney deficiency and heart blood deficiency may present with anxiety characterized by a sense of impending doom, poor memory, insomnia, and/or palpitations.

Tinnitus due to Depleted Kidney-Essence is associated with aging. It is characterized by low sound and a slow progressive onset of symptoms. Fear, sore knees, achy back, slight dizziness, and poor memory may also be present. 

Tinnitus due to Deficient Kidneys begins with a gradual onset of symptoms that include sounds of rushing water and ringing ears. Afternoon-evening sweats and/or hot flashes may be present.

Massage helps relieve tinnitus symptoms by reducing stress and relieving muscle tension.  It can relax the head, neck, and jaw muscles, which stresses the inner ear. Regular massages can also help resolve postural problems that contribute to tinnitus.

Massage Recommendations For Tinnitus

Massage can target points around the ear and neck to relieve tinnitus symptoms. The meridians of the heart, small intestine, pericardium, gallbladder, and liver can also be used.

Self-care for tinnitus might include pulling the bottom of the earlobe laterally and upwards in a stretching motion, which helps to reduce inner ear fluid buildup and relieve ringing sensations.

Massaging the mastoid process with gentle Swedish massage can relieve tension in the neck and ear muscles and allow the neck to move back into the correct alignment.

The masseter is the strongest muscle in the body in proportion to its size, and when overly tense, it can contribute to misalignment of the jaw and ringing in the ear. Any massage intended to relieve tinnitus will focus effort on the masseter muscle.

Acupressure points around the ears relieve tinnitus along with the pericardium, small intestine, and heart meridians. Gua sha is another therapeutic technique for releasing areas of tension.

Contraindications Of Tinnitus Massage Treatments

Some contraindications for tinnitus may include heightened sensitivity to touch, light, and sound. Craniosacral therapy would be recommended to relieve the strain patterns in the meningeal membrane system that wraps the brain and spinal cord. These fascial layers can develop strain patterns or become injured through trauma.

In one case study, a patient showed a reversal of tinnitus symptoms after 2.5 months of soft tissue massage, repetitive movements, and joint mobilization.

Sources:

https://www.ncbi.nlm.nih.gov/books/NBK11122/

http://tcmwindow.com/diseases/Nervous-System-Diseases/Tinnitus-symptoms.shtml

https://pubmed.ncbi.nlm.nih.gov/14689631/ 

https://www.nidcd.nih.gov/health/tinnitus
https://www.health.harvard.edu/newsletter_article/tinnitus-ringing-in-the-ears-and-what-to-do-about-it

https://hms.harvard.edu/news/reversing-hearing-loss

http://tcmwindow.com/diseases/Nervous-System-Diseases/Tinnitus-diagnosis.shtml

Circulation problem around ear, neck, shoulder, ears are opening 

https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2022.986805/full

https://my.clevelandclinic.org/health/symptoms/14164-tinnitus 

https://www.rmtedu.com/blog/cervicogenic-tinnitus-and-massage-therapy

Causes Tinnitus according to CMT

http://tcmwindow.com/diseases/Nervous-System-Diseases/Tinnitus-causes.shtml

Clinical Trial - no approved meds or treatments

https://www.frontiersin.org/journals/pharmacology/articles/10.3389/fphar.2022.844730/full#B13

Youtube: 

Gua Sha https://www.youtube.com/watch?v=xUiJbQXrEq4 

 

Massage Therapy for Insomnia

Insomnia is a common sleep disorder characterized by difficulty falling asleep, staying asleep, or going back to sleep. This results in poor sleep quality and can lead to daytime impairment and distress. For many people, it’s common to experience short-term insomnia at some point in their lives, which can last for a few days or weeks. But for others, insomnia can become chronic, lasting for months or more. 

Most adults need 7 to 9 hours of sleep a night. If the body does not get enough sleep, it will lack the energy and ability to function completely and optimally. This can compromise things like the immune system, physical performance, cognition, hormonal balance, mood swings, and more — virtually all aspects of the human body. 

Causes of Insomnia

Insomnia is often associated with what western medicine refers to as the circadian rhythm. Also called the biological clock, the circadian rhythm is the series of physiological changes an organism experiences over a 24-hour cycle. The biggest influence on the circadian rhythm is light intake, followed by diet, stress, physical activity, temperature, and social environment. 

For example, things that may interfere with the circadian rhythm include:

• Not getting enough daylight during the day 
• Thinking about life concerns that keep the mind up at night
• Bedtime habits that prevent the body from relaxing before trying to sleep (such as working, eating, watching screens, etc.)
• Consuming any food, medication, or substances that contain stimulants (like caffeine) too late or too early in the day
• Medical conditions that cause pain or disrupt sleeping (such as sleep apnea, which inhibits breathing)

Insomnia is one of the most common symptoms of an irregular circadian rhythm. It is a natural consequence of an offset biological clock, reflecting the body’s inability to relax at appropriate times of the day. If the circadian rhythm is offset for an extended amount of time, it will result in negative health effects that may eventually compound into more serious health conditions later on. 

Treating Insomnia

In western medicine, there are two primary ways to treat insomnia: prescription medication, or cognitive behavioral therapy (CBT).

Prescription sleeping pills can help the body fall asleep and stay asleep, but generally doctors do not recommend relying on them for more than a few weeks, as they often come with negative side effects, such as cognitive or physical impairment. 

Alternatively, behavioral therapy, which is usually recommended as the first treatment for insomnia, involves developing habitual strategies to control or stop thoughts and actions that keep the mind awake. This includes stimulus control therapy (which helps associate the bed with sleep, specifically), light therapy, nutrition therapy, and sleep restriction (restricting naps). Some doctors may also prescribe certain relaxation methods, such as breathing exercises, meditation, or massage therapy. 

TCM and Insomnia

Traditional Chinese Medicine (TCM) approaches the causes and treatments for insomnia from a holistic perspective, focusing on the balance of the body's energy (Qi), blood, and organs. TCM recognises different types of insomnia, each with its unique set of causes and symptoms. Depending on the diagnosed type of insomnia, TCM will utilize a combination of herbal medicine, massage, acupuncture, dietary adjustments, and lifestyle modifications. 

From a TCM perspective, insomnia is heavily associated with stress and anxiety, which can correlate with certain organs and their meridians. Here are a few examples of the energetic causes of insomnia, according to TCM:

• Kidney Yin Deficiency. The health of the kidneys reflect the quality of energy, youth, and vitality in the body. A deficiency of yin energy in the kidneys can contribute to insomnia. 
• Heart Disharmony. The heart is affected by all emotions. Both deficiency or excess in the heart may contribute to insomnia by affecting its synergy with other organs. 
• Liver Stagnation and Deficiency. The liver is strongly affected by stress and frustration. Frequent stress can stagnate the liver energy, which can cause insomnia. Deficiency of liver blood can also be a cause.

Massage for Insomnia

Massage therapy can be an effective complementary treatment for insomnia, with no contraindications. However, for the best treatment, it is recommended to use all and any strategies to specifically promote relaxation. 

In the massage room, this can include using a combination of soft lighting, soothing music, and temperate heating. During the intake, using rhetoric that emphasizes thoughts of positivity and healing may also help promote the healing process on a psychological level by directing the mind away from current stressors. For the massage itself, techniques that are generally calming (rather than vigorous or energizing) should be prioritized. 

Overall, any general relaxation massage will help treat insomnia. However, by identifying the organs involved with insomnia, according to TCM, certain acupressure points can be integrated into the massage pattern, thus improving the effectiveness of the treatment. Here are some acupressure points that can help insomnia, taken from “Acupuncture Points Handbook” by Deborah Bleecker: 

Head

• Du 20. Top of the head, aligned with top of ears. (p.71)
• Si Shen Cong – Four Alert Spirit. A group of four points located one finger (1 cun) away from Du 20 in each direction. (p.247)
• Yin Tang – Hall of Impression, or Spirit Gate. Midway between medial ends of eyebrows. (p.251)
• An Mian – Peaceful Sleep. Calms the spirit. Treats insomnia. Located 1 finger behind the earlobe. (p.236)

Hands

• Heart 7. Important point for calming the body. Located in the ulnar side (little flinger) wrist crease, on the later side of the tendon. (p.103)
• Heart 8. Between fourth and fifth metacarpal bones, where the little finger can touch the palm. (p.104)
• Pericardium 6 – The Insomnia Point. “Acupressure done with a magnetic pellet is very effective to treat insomnia. Just place the magnetic pellet on the point an hour or so before bed, and take it off in the morning. It will help you get to sleep and stay asleep all night.” Located 2 fingers (2 cun) above the wrist crease, between the tendons in the midline of forearm. (p. 159).
• Pericardium 7. In the middle of the wrist crease, between the tendons. (p.161)

Feet

• Kidney 1. Sole of foot in center depression when the foot is flexed. (p.106)
• Kidney 3. The “most important point of the Kidney”. Treats insomnia due to kidney weakness. Located in the depression in midpoint between the medial ankle bone and back of leg. (p.107)
• Kidney 6. Major point for insomnia. Located in depression directly below ankle bone. (p.111)
• Spleen 6. A multifunctional point that regulates and strengthens the Spleen, Stomach, Kidneys, and Liver. Very calming and treats the underlying cause of insomnia. Located 3-4 fingers (3 cun) above the tip of the medial ankle bone. (p.189)
• Liver 2. Major point that treats stress and excess liver energy. Located between the big toe and second toe, in the web margin. (p.137)
• Liver 3. Relieves stress and anger. Very relaxing. Slightly above the web of Liver 2. (p.139)

Back

• Bladder 15. On back erectors, between T5 and T6. (p.42)

References

Insomnia. https://www.mayoclinic.org/diseases-conditions/insomnia/symptoms-causes/syc-20355167

The beneficial effects of massage therapy for insomnia in postmenopausal women. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4521661/

Circadian Rhythms. https://www.nigms.nih.gov/education/fact-sheets/Pages/circadian-rhythms.aspx#:~:text=Study%20Circadian%20Rhythms-,What%20Are%20Circadian%20Rhythms%3F,and%20temperature%20also%20affect%20them.

Circadian Rhythm Sleep Disorders. https://my.clevelandclinic.org/health/diseases/12115-circadian-rhythm-disorders

The Different Types of Insomnia in Chinese Medicine. https://healthinflow.com.au/the-different-types-of-insomnia-in-chinese-medicine/

The effect of classical foot massage on insomnia and anxiety in preeclamptic pregnant women: a randomized controlled study. https://pubmed.ncbi.nlm.nih.gov/38422316/ 

Massage Therapy Can Help Improve Sleep. amtamassage.org/about/position-statements/massage-therapy-can-help-improve-sleep/

New Research Continues to Support Massage for Improving Sleep Quality. amtamassage.org/about/news/massage-for-sleep-research/

Randomized control trial evidence for the benefits of massage and relaxation therapy on sleep in cancer survivors—a systematic review. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8448699/

Sleep Toolkit: Tools for Optimizing Sleep & Sleep-Wake Timing | Huberman Lab Podcast #84. https://www.youtube.com/watch?v=h2aWYjSA1Jc

Benefits of Massage Therapy for Ankylosing Spondylitis

What is Ankylosing Spondylitis?

 

Ankylosing Spondylitis(AS) is an autoimmune arthritic disease that is known for creating prolonged inflammation of the spine and ligaments of the spine. Over time, this disease creates rigidity of the spinal column. The chronic inflammation can cause calcium deposits to form on the ligaments and around the intervertebral discs, which effectively fuses vertebrae together over time. It is commonly diagnosed in early adulthood and is a lifelong disease.

How is AS Managed with Western Medicine?

Although this disease is commonly recognized in Western medicine as incurable, there are multiple avenues of treatment that can slow the progression and help with client comfort. Some of said treatments include:

- Anti-inflammatory drugs (NSAIDS)  

- Corticosteroids (e.g. Prednisone, Hydrocortisone, Cortisone) can by injected directly into the joints or taken orally

- Physical therapy (e.g. Yoga, Range of Motion exercises, stretching) keeps blood moving through the spine

- Surgical Intervention 

How is AS Managed with Eastern Medicine?

AS is viewed as a deficiency of Kidney and Liver Qi and is qualified as a ‘Bi Syndrome’, which is a TCM term for blocked Qi in the meridians due to the external introduction of cold, wind, and damp.

Some treatments include:

- Herbal Formulas to build blood and Qi

- Acupuncture to recover Qi flow along Kidney and Liver meridians 

- Moxibustion is used to introduce heat and movement to stagnant areas

Cautions and Contraindications to Massage Therapy 

Cautions:

- Any pressure at all can feel painful. If massage is too painful, then stopping the session is advised.

- Medications are often anti-inflammatory so any technique that produces excessive inflammatory results should be limited

- Pain medications may also be prescribed so perception of pain may be unreliable

Contraindications:

- Spinal manipulation can lead to serious injury, including fractures and neurological symptoms

- Massage could trigger flare-ups of inflammation along the spine 

- Deep tissue on clients with progressed spinal fusion can increase pain and sensitivity and may induce neurological symptoms 

Benefits of Massage Therapy on a Client with AS

- Improved blood circulation to Spine and joints

- Improved lymphatic function, which will help get rid of metabolic waste

- Increase in mobility 

- Release of muscle tension

- Reduction of pain and stiffness

- Reduction of depression and anxiety symptoms

Modifications for a Client with AS

- Lighter pressure massage is recommended to begin with. Medium pressure may be applied if the client is comfortable

- Check-in with the client in regards to pressure and comfort level frequently

- Possible neck pillow and larger bolster may be required depending on the progression of the disease and comfort level of the client

- Deep Pressure is generally ill-advised, although deep tissue vibration techniques may be indicated

Sources: 

https://www.niams.nih.gov/health-topics/ankylosing-spondylitis#:~:text=Ankylosing%20spondylitis%20is%20a%20type,help%20us%20move%20and%20bend

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8051999/#:~:text=Several%20systematic%20reviews%20and%20meta,the%20treatment%20of%20ankylosing%20spondylitis

https://www.mayoclinic.org/diseases-conditions/ankylosing-spondylitis/diagnosis-treatment/drc-20354813

https://www.researchgate.net/publication/45284133_Bi_Syndrome_Arthralgia_Syndrome

https://www.spandidos-publications.com/10.3892/ijmm.2013.1481

https://www.medicalnewstoday.com/articles/ankylosing-spondylitis-massage#massage-chairs

https://spondylitis.org/about-spondylitis/treatment-information/integrative-medicine/#:~:text=%22Anyone%20with%20limited%20spinal%20mobility,fusion%20(extra%20bone%20growth)

https://www.noterro.com/blog/the-benefits-of-massage-for-ankylosing-spondylitis#:~:text=Overview%20of%20Ankylosing%20Spondylitis&text=There's%20no%20cure%2C%20but%20massage,million%20Americans%20have%20Ankylosing%20Spondylitis