A study on Tai Ji exercise and traditional Chinese medical modalities in relation to bone structure, bone function and menopausal symptoms.Osteoporosis is a multifactorial multifactorial /mul·ti·fac·to·ri·al/ (mul?te-fak-tor´e-al) 1. of or pertaining to, or arising through the action of many factors. 2. disease associated with diet, exercise, genetics and hormones. It is characterised by low bone mass and microarchitectural deterioration of bone tissue, leading to enhanced bone fragility and a consequent increase in fracture risk. Women of post-menopausal age are at particular risk. The role of traditional Chinese medicine Traditional Chinese Medicine Definition Traditional Chinese medicine (TCM) is an ancient and still very vital holistic system of health and healing, based on the notion of harmony and balance, and employing the ideas of moderation and prevention. (TCM (1) (Trellis-Coded Modulation/Viterbi Decoding) A technique that adds forward error correction to a modulation scheme by adding an additional bit to each baud. TCM is used with QAM modulation, for example. ) related modalities Modalities The factors and circumstances that cause a patient's symptoms to improve or worsen, including weather, time of day, effects of food, and similar factors. in preventing and managing the disease has received little attention in well-designed research in western countries. This study examined the effects of physical activity in the form of Tai Ji Tai Ji can refer to:
T'ai chi is a Chinese exercise system that uses slow, smooth body movements to achieve a state of relaxation of both body and mind. ), acupuncture acupuncture (ăk`y  pŭng'chər), technique of traditional Chinese medicine, in which a number of very fine metal needles are inserted into the skin at specially designated points. and Chinese herbal medicine Chinese herbal medicinesee herbal medicine. on bone loss by evaluating bone structure and function in menopausal women. At the same time, any changes in the severity of other menopausal signs and symptoms were also monitored. Outcome measures Dual Energy X-ray Absorptionmetry (DEXA DEXA, n.pr See dual-energy x-ray absorptiometry. ) provides a measurement of bone mineral density bone mineral density n. See bone density. bone mineral density A measurement of bone mass, expressed as the amount of mineral–in grams divided by the area scanned in cm2. See Bone densitometry. (BMD BMD In currencies, this is the abbreviation for the Bermudian Dollar. Notes: The currency market, also known as the Foreign Exchange market, is the largest financial market in the world, with a daily average volume of over US $1 trillion. ) (expressed as g/cm2) throughout the whole body and is generally the most reliable means of assessing osteoporosis to date. However, DEXA has limitations in terms of cost and availability of equipment, and requires exposure to potentially harmful X-rays. As an alternative this study used broadband ultrasound attenuation Loss of signal power in a transmission. Attenuation The reduction in level of a transmitted quantity as a function of a parameter, usually distance. It is applied mainly to acoustic or electromagnetic waves and is expressed as the ratio of power densities. (BUA) as a measure of bone structure and density which is increasingly being used in osteopenic screening programmes. The results of BUA were compared with DEXA at the end of the study. DEXA testing was only available at the end of the study due to the lack of availability of equipment and the need to restrict the number of such tests to minimise exposure to x-rays. Low bone density results from either a reduction in the rate of bone growth and/or an increase in the rate of bone resorption Bone resorption is the process by which osteoclasts break down bone and release the minerals, resulting in a transfer of calcium from bone fluid to the blood. The osteoclasts are multi-nucleated cells that contain numerous mitochondria and lysosomes. to a level where there is a net loss of bone. In this study, serum osteocalcin (OSTN OSTN Open Student Television Network ) was taken as a biomarker of bone formation while pyridinoline (PYR PYR Pyrrolidonyl Aminopeptidase PYR Per Your Request PYR Prior Year Report ) and doxypyridinoline (D-PYR) levels in urine were used as markers of bone resorption. TCM diagnosis was also used to measure changes in participants' observable and reported menopausal symptoms. Research design A paired crossover group research design was used. Forty women undergoing menopause (average age 49.3 years) were recruited and divided into three groups: 12 into a Tai Ji exercise group, 14 into an acupuncture treatment group, and 14 into a herbal treatment group. Each group was split into two sub-groups of equivalent bone structure and function as determined by their broadband ultrasonic attenuation (BUA) and with reference to their menopausal status and age. One sub group initially became a treatment group while the other maintained a normal lifestyle as the control group. At the conclusion of the initial treatment period of four months, the groups "crossed over" and the control became the experimental groups and the initial experimental groups became the control. The second treatment period also continued for four months. Three sets of tests were administered: at the beginning of the study, after four months and after eight months. Dietary information regarding calcium intake was recorded by questionnaire at the time of testing. This was done to ensure that there was no significant change in the participants' nutritional practices. Similarly, the participants' level of physical activity was recorded by questionnaire at the beginning of the study and re-examined to ensure no other changes in exercise regimes had occurred. Tai Ji group Subjects in the Tai Ji group completed thirty-two one hour sessions of Beijing 24-movements Tai Ji over sixteen weeks. These movements are designed to gather qi, focus the mind, relax the body, move qi and blood, and exercise the muscles, joints and lumbar region (Anat.) the region of the loin; specifically, a region between the hypochondriac and iliac regions, and outside of the umbilical region. See also: Lumbar . The results of this study indicated that Tai Ji improved bone structure and increased bone density in menopausal women. There was a 5.3dB/ MHz (MegaHertZ) One million cycles per second. It is used to measure the transmission speed of electronic devices, including channels, buses and the computer's internal clock. A one-megahertz clock (1 MHz) means some number of bits (16, 32, 64, etc. increase in BUA (p = 0.001) when comparing the test results before and after the course of Tai Ji. The increased BUA appears to be associated with a significant increase in bone formation (p = 0.001) rather than decreased bone resorption (p>0.05). It appears that Tai Ji exercise may not only improve balance and confidence in the elderly but also could contribute to improved bone function and structure. Acupuncture group The subjects who received acupuncture therapy were assessed according to according to prep. 1. As stated or indicated by; on the authority of: according to historians. 2. In keeping with: according to instructions. 3. TCM principles. Three main acupuncture points This is a list of acupuncture points, sorted by meridian. They are given by their Chinese name in pinyin, but are also known by the abbreviation for the meridian and the number. For example, Zhongfu (the first point along the lung meridian) is also known as LU1. : Taixi KID-3, Sanyinjiao SP-6 and Zusanli ST-36 were used for each of the fourteen participants, using uniform reinforcing-reducing technique. Each participant was treated 32 times by the researcher, twice a week for 16 weeks, with each treatment lasting 30 minutes. The use of specific acupuncture points on the Kidney, Stomach and Spleen spleen, soft, purplish-red organ that lies under the diaphragm on the left side of the abdominal cavity. The spleen acts as a filter against foreign organisms that infect the bloodstream, and also filters out old red blood cells from the bloodstream and decomposes channels meant that their related zangfu (organs) were tonified, nourished nour·ish tr.v. nour·ished, nour·ish·ing, nour·ish·es 1. To provide with food or other substances necessary for life and growth; feed. 2. and regulated. In a comparison of tests immediately before and after the course of acupuncture treatment, there was a significant increase in BUA readings by 6.4dB/MHz (p = 0.005.) Pre and post treatment comparison also showed that the balance between bone formation and resorption resorption /re·sorp·tion/ (re-sorp´shun) 1. the lysis and assimilation of a substance, as of bone. 2. reabsorption. re·sorp·tion n. improved, with a significant increase in OSTN (p = 0.006) and a significant reduction of D-PYR (p = 0.002). The reduction in PYR was not statistically significant. Herbal group The participants who were to receive herbal therapy were assessed according to the principles of TCM. A Shu Di Huang (Radix The base value in a numbering system. For example, in the decimal numbering system, the radix is 10. (mathematics) radix - The ratio, R, between the weights of adjacent digits in positional representation of numbers. Rehmanniae Glutinosae Conquitae) and Shan Zha (Fructus Crataegi) formula was selected for the treatment group. The decoction DECOCTION, med. jurisp. The operation of boiling certain ingredients in a fluid, for the purpose of extracting the parts soluble at that temperature. Decoction also means the product of this operation. 2. (granules Granules Small packets of reactive chemicals stored within cells. Mentioned in: Allergic Rhinitis, Allergies mixed with water) was taken twice per day over a period of four months to tonify Kidney qi, nourish nour·ish v. To provide with food or other substances necessary for sustaining life and growth. yin and invigorate in·vig·or·ate tr.v. in·vig·or·at·ed, in·vig·or·at·ing, in·vig·or·ates To impart vigor, strength, or vitality to; animate: "A few whiffs of the raw, strong scent of phlox invigorated her" blood. All 14 participants showed improvements over the course of treatment, with the level of BUA increasing significantly by 4.4dB/MHz (p = 0.03) accompanied by a significant reduction in D-PYR (p = 0.011). The combined data from pre and post treatment testing also indicated a decreasing trend in PYR but the result was not statistically significant (p = 0.071). OSTN levels also increased significantly (p = 0.029). Summary Broadband ultrasound attenuation (BUA) was higher after the treatment with all three treatment modalities. Increased levels of osteocalcin (OSTN) in serum and the decreased levels of pyridinoline (PYR) and doxypyridinoline (D-PYR) in the urine were all noted after treatment and might explain the increased BUA. Results of dual energy X-ray absorbtionmetry (DEXA) in the same subjects had a moderate correlation with the BUA readings (r = 0.50). Regardless of the therapy group, there was a noticeable decline in BUA readings during the period each sub-group acted as the control for four months (i.e. no treatment). This natural decline seems to be part of the normal post-menopausal process. Results suggest that each of the three therapies was capable of holding back and reversing this decline, but that there was little residual effect after cessation of treatment. Common menopausal symptoms In TCM, the menopause is viewed as a natural progression in life, and any patterns of disharmony dis·har·mo·ny n. 1. Lack of harmony; discord. 2. Something not in accord; a conflict: "the disharmonies that assail the most fortunate of mortals" Peter Gay. that result tend to arise in specific ways depending upon a woman's constitutional make-up. There are however common patterns of disharmony that broadly encompass yin and qi deficiency related to the Kidney, Spleen and Liver. Hot flushes, night sweats, insomnia insomnia, abnormal wakefulness or inability to sleep. The condition may result from illness or physical discomfort, or it may be caused by stimulants such as coffee or drugs. However, frequently some psychological factor, such as worry or tension, is the cause. and headache are typical menopausal symptoms caused by yin deficiency and deficient heat. Lumbar lumbar /lum·bar/ (lum´bar) pertaining to the loins. lum·bar adj. Of, near, or situated in the part of the back and sides between the lowest ribs and the pelvis. and knee pain stems from Kidney deficiency, and the Kidneys' role in water metabolism may lead to swollen ankles. Oedema oedema see edema. of the ankles or fingers may also result from qi deficiency affecting the Spleen, as may symptoms such as abdominal distension Abdominal distension (or "Distended abdomen") can be a sign of many other conditions, including:
Tai Ji Table 4 shows the results of four months of Tai Ji exercise treatment on the main TCM symptoms related to the menopause. Using Ridit analysis, some major symptoms were shown to be relieved by Tai Ji exercise, i.e. abdominal distension, tiredness, hot flushes and night sweats to a significant degree. The table also illustrates, even though the results are not statistically significant, that there is a clear shift of participants from mild or medium symptom levels towards reduced symptoms. Tai Ji can improve the general qi and blood circulation, tonify qi and unblock un·block tr.v. un·blocked, un·block·ing, un·blocks To remove or clear an obstruction from: unblock a road; unblock an artery. the channels. These improvements result in the relief of the symptoms of menopause. The movements are balanced and use the lumbar region as a pivot to stretch and relax the back muscles. According to TCM, hot flushes, insomnia or sleeplessness, tiredness, pain in the lower back and legs are all associated with Kidney deficiency. As the Kidneys are located in the lumbar region this exercise particularly benefits Kidney function. Acupuncture The use of points Taixi KID-3, Sanyinjiao SP-6 and Zusanli ST-36 is appropriate for each of the TCM patterns of Kidney deficiency, yin deficiency and qi deficiency. Most of the major symptoms i.e. lower back pain, knee/leg/foot pain, abdominal distension, swollen ankles/fingers, tiredness, palpitations, hot flushes, night sweats, insomnia, headache and thirst were relieved to a statistically significant level by acupuncture treatment (Table 5). Herbal therapy Table 6 shows the results of four months of herbal treatment on common menopausal symptoms. There were statistically significant changes in seven symptoms i.e. lower back pain, tiredness, hot flushes, night sweats, insomnia headache and thirst. Other symptoms clearly produced improvements even where they could not be considered to be statistically significant. Tables 4, 5 and 6 indicate that acupuncture produced a greater number of statistically significant improvements in symptoms than the other two modalities. Acupuncture proved more effective in treating palpitations. Acupuncture and herbal treatment were more effective in treating irritability/anxiety/stress. Herbal treatment was more effective in treating constipation, demonstrating the effectiveness of the herbs in nourishing nour·ish tr.v. nour·ished, nour·ish·ing, nour·ish·es 1. To provide with food or other substances necessary for life and growth; feed. 2. yin (body fluid). As this study only used single treatment modalities the effects of using more than one treatment modality at the same time is unknown. In TCM clinical practice, more effective treatment often involves the use of more than one modality modality /mo·dal·i·ty/ (mo-dal´i-te) 1. a method of application of, or the employment of, any therapeutic agent, especially a physical agent. 2. and this suggests that further study is required. According to TCM principles the causes and patterns of osteoporosis and menopause are clear. Rather than provide symptomatic treatment Symptomatic treatment is any medical therapy of a disease that only affects its symptoms, not its cause, i.e., its etiology. It is usually aimed at reducing the signs and symptoms for the comfort and well-being of the patient, but it also may be useful in reducing organic , TCM focuses on the underlying cause and provides a comprehensive therapy to treat the root of the disease as well as the symptoms to achieve a holistic result. TCM views osteoporosis as primary deficiency and secondary excess. The pattern differentiation in TCM considers osteoporosis to be Liver and Kidney deficiency combined with qi and blood deficiency as the primary disharmony. Cold damp, phlegm phlegm humor effecting temperament of sluggishness. [Medieval Physiology: Hall, 130] See : Laziness and blood stasis stasis /sta·sis/ (sta´sis) 1. a stoppage or diminution of flow, as of blood or other body fluid. 2. a state of equilibrium among opposing forces. are the secondary disharmony. The symptoms of the various patterns include back pain, weak knees and tiredness. Back pain is a common symptom of bone loss resulting from Kidney deficiency. Appearing initially as a sore ache in the body with weak knees and tiredness, this develops into significant pain when affected by external or internal factors. If prevention or treatment (once the disease exists) is not applied in time, the development of osteoporosis increases the risk of lumbar vertebra vertebra /ver·te·bra/ (ver´te-brah) pl. ver´tebrae [L.] any of the 33 bones of the vertebral (spinal) column, comprising 7 cervical, 12 thoracic, 5 lumbar, 5 sacral, and 4 coccygeal vertebrae . and hip fracture hip fracture Orthopedic surgery A femoral fracture which affects 1/6 white ♀–US during life Epidemiology 250,000/yr–US Specifics Proximal femur; 90+% femoral neck, intertrochanteric; 5-10% are subtrochanteric Risk factors Tall, thin ♀, , spinal deformities, and limited movement in the lumbar region, hips and knee joints. TCM offers preventive treatment preventive treatment n. See prophylactic treatment. with such interventions as Tai Ji, acupuncture and herbal medicine herbal medicine, use of natural plant substances (botanicals) to treat and prevent illness. The practice has existed since prehistoric times and flourishes today as the primary form of medicine for perhaps as much as 80% of the world's population. . All three TCM modalities utilised in this study provided relief to patients suffering from menopausal symptoms and in some cases the relief was statistically significant. The findings also indicate that these modalities could be used as a basic treatment and preventative therapy for menopausal symptoms as well as osteoporosis. The results of the study imply that the three TCM therapeutic strategies might delay the occurrence of bone loss by improving the balance of bone turn over and general health in menopausal women. Further investigations would be required to determine that the modalities of Tai Ji exercise, traditional Chinese acupuncture therapy and traditional Chinese herbal therapy assist in the prevention and/or treatment of problems associated with bone structure and function in other population groups. Other likely target groups would be people suffering ongoing physical disability or those recovering from osteoporotic fractures and who are currently receiving other therapies. The herbs and acupuncture points used in the treatments are commonly used as they are neutral in nature and will suit most of the population. For patients who are suffering from osteoporosis, long-term use of these therapies is recommended. This could be combined with other stronger treatments based on the above mentioned principles. Dr. Hong Xu has thirteen years experience in Chinese Medicine education, research and practice in Australia, China and Hong Kong Hong Kong (hŏng kŏng), Mandarin Xianggang, special administrative region of China, formerly a British crown colony (2005 est. pop. 6,899,000), land area 422 sq mi (1,092 sq km), adjacent to Guangdong prov. . She is Acting Coordinator of Chinese Medicine and Coordinator of Chinese Herbal Medicine at the School of Health Sciences, Victoria University, Melbourne, Australia. Professor David Lawson You may be looking for David J. Lawson, American pastor. David Lawson, (c. 1720 – c. 1803), was a Scottish immigrant who settled on Prince Edward Island. He was, at various times and circumstances, a farmer, a land agent and a politician. recently retired from Victoria University where he held the position of Pro-Vice-Chancellor (International). He has been working in the area of Applied Physiology with a special interest in Special Populations for over 30 years. Ms Annette Kras holds an Advanced Diploma of Traditional Chinese Medicine and works as a Traditional Chinese Medicine practitioner in Melbourne.
Table 1: Effects of Tai Ji on BUA and bone turnover markers (n = 12)
Pre-Treatment Post-treatment
BUA (dB/MHz) 72.5 [+ or -] 13.4 77.8 [+ or -] 12.8
Osteocalcin (OSTN) (ng/ml) 14.6 [+ or -] 7.8 20.3 [+ or -] 9.9
Pyridinoline (PYR) 61.9 [+ or -] 17.3 56.8 [+ or -] 22.1
(nmol/mmol Cr)
Deoxypyridinoline (D-PYR) 12.7 [+ or -] 4.3 11.1 [+ or -] s5.0
(nmol/mmol Cr)
Change P
BUA (dB/MHz) 5.3 0.001
Osteocalcin (OSTN) (ng/ml) 5.7 0.001
Pyridinoline (PYR) -5.1 0.272
(nmol/mmol Cr)
Deoxypyridinoline (D-PYR) -1.6 0.079
(nmol/mmol Cr)
Table 2: Effects of Acupuncture on BUA and bone turnover markers
(n = 14)
Pre-Treatment Post-treatment
BUA (dB/MHz) 73.0 [+ or -] 14.8 79.4 [+ or -] 17.9
Osteocalcin (OST-N) (ng/ml) 18.8 [+ or -] 8.4 24.6 [+ or -] 7.2
Pyridinoline (PYR) 66.4 [+ or -] 14.6 62.8 [+ or -] 18.9
(nmol/mmol Cr)
Deoxypyridinoline (D-PYR) 66.4 [+ or -] 14.6 11.9 [+ or -] 4.0
(nmol/mmol Cr)
Change P
BUA (dB/MHz) 6.4 0.005
Osteocalcin (OST-N) (ng/ml) 5.7 0.006
Pyridinoline (PYR) -3.6 0.493
(nmol/mmol Cr)
Deoxypyridinoline (D-PYR) -2.7 0.002
(nmol/mmol Cr)
Table 3: Effects of Herbal Therapy on BUA and bone turnover markers
(n = 14)
Pre-Treatment Post-treatment
BUA (dB/MHz) 63.6 [+ or -] 13.7 68.0 [+ or -] 15.1
Osteocalcin (OST-N) 19.4 [+ or -] 11.0 23.6 [+ or -] 10.5
(ng/ml)
Pyridinoline (PYR) 73.0 [+ or -] 18.0 64.5 [+ or -] 17.0
(nmol/mmol Cr)
Deoxypyridinoline (D-PYR) 17.0 [+ or -] 4.6 14.2 [+ or -] 4.2
(nmol/mmol Cr)
Change P
BUA (dB/MHz) 4.4 0.03
Osteocalcin (OST-N) 4.2 0.029
(ng/ml)
Pyridinoline (PYR) -8.5 0.071
(nmol/mmol Cr)
Deoxypyridinoline (D-PYR) -2.8 0.011
(nmol/mmol Cr)
Table 4: Effects of Tai Ji on Common Symptoms (n = 12)
Pre-Treatment Post-Treatment Ridit p **
Symptom */
Number of subjects Degree of Degree of
Symptom * Symptom *
0 1 2 3 0 1 2 3
Lower back pain 5 3 3 1 9 2 1
Knees/Leg/Feet 8 1 3 11 2
Abdominal 5 5 2 10 2 <0.05
Diarrhoea 11 1 12
Swollen 8 2 2 10 2
Tiredness 7 3 2 11 1 <0.05
Palpitations 9 2 1 12
Hot flushes 3 5 4 9 3 <0.01
Night sweats 4 4 4 9 3 <0.05
Insomnia 9 1 2 10 2
Irritability/Anxiety 8 3 1 8 2 2
Headache 8 2 2 10 2
Thirst 7 5 10 2
Itchy skin 9 2 1 10 2
Constipation 9 1 1 1 9 1 2
Dark/smelly urine 8 1 3 9 3
* 0 = No symptoms; 1 = Mild symptoms; 2 = Medium symptoms; 3 = Severe
symptoms
** Ridit analysis showing symptom relief of statistically significant
level.
Table 5: Effects of Acupuncture on Common Symptoms (n=14)
Pre-Treatment Post-Treatment
Symptom */ Degree of Degree of Ridit p**
Number of subjects Symptoms * Symptom *
0 1 2 3 0 1 2 3
Lower back pain 2 5 4 3 8 5 1 <0.01
Knees/Leg/Feet 5 2 4 3 10 4 <0.01
Abdominal 8 3 2 1 13 1 <0.05
Diarrhoea 9 5 13 1
Swollen 8 2 2 2 14 <0.01
Tiredness 2 7 2 3 13 1 <0.01
Palpitations 7 6 1 12 2 <0.05
Hot flushes 5 8 1 5 9 <0.01
Night sweats 1 7 5 1 11 3 <0.01
Insomnia 3 6 3 2 8 5 1 <0.05
Irritability/Anxiety 9 2 2 1 12 1 1
Headache 4 1 7 2 7 7 <0.01
Thirst 4 3 5 2 9 3 2 <0.05
Itchy skin 13 1 #
Constipation 8 5 3 9 6 1
Dark/smelly urine 7 3 3 1 11 2 1
* 0 = No symptoms; 1 = Mild symptoms; 2 = Medium symptoms; 3 = Severe
symptoms
** Ridit analysis showing symptom relief of statistically significant
level.
Table 6: Effects of Herbal Treatment on Common Symptoms (n = 14)
Pre-Treatment Post-Treatment
Symptom */
Number of subjects Degree of Degree of Ridit p**
Symptoms * Symptom *
0 1 2 3 0 1 2 3
Lower back pain 7 4 2 1 12 2 <0.05
Knees/Leg/Feet 10 4 1 13 1
Abdominal 7 4 3 10 3 1
Diarrhoea 13 1 14
Swollen 13 1 1 13 1
Tiredness 4 4 6 13 1 <0.01
Palpitations 9 3 2 13 1
Hot flushes 1 8 5 0 9 5 <0.01
Night sweats 4 4 6 7 7 <0.05
Insomnia 1 8 5 11 3 <0.01
Irritability/Anxiety 8 1 2 3 11 3
Headache 4 5 5 7 7 <0.05
Thirst 4 6 2 2 12 2 <0.01
Itchy skin 12 1 1 14
Constipation 8 3 2 1 12 1 1
Dark/smelly urine 12 2 12 2
* 0 = No symptoms; 1 = Mild symptoms; 2 = Medium symptoms; 3 = Severe
symptoms
** Ridit analysis showing symptom relief of statistically significant
level.
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