Articles
Clinic Pearl: Plum Blossom Needle
I chose to write about an acute articular soft tissue injury treated by a blood-
letting puncture with plum-blossom needle and cupping. Plum blossom needle and cupping is a
technique that I had never practiced at the school clinic while I was a student of Oriental
Medicine. I was introduced to the theory and its benefits and effects in class only. For the type of
practitioner that I found myself to be (one who is willing to cause minimum to no pain to my
patients, and perform rather gentle treatments), this technique always seemed to me a bit invasive
and causing more pain to patient’s body than necessary. Recently two patients’ conditions
required my brain to think outside of what I have been practicing so far, which is: almost pain
free, gentle acupuncture, cupping and tuina for acute neck and shoulder pain, caused by external
wind invasion. First, a male patient, truck driver, air conditioning draft day and night, and
second, a female patient experiencing whiplash from a car accident. I have been treating both
patients previously for various body discomforts and my usual treatment involving needles,
cupping and tuina has always produced satisfactory pain relief within a short period of time.
This time, the male patient was experiencing neck pain for a couple of weeks. He saw a
chiropractor twice and he came for acupuncture treatment twice, but the pain was still not
relieved. The patient grew impatient, so I explained the plum blossom needle technique to him,
and he agreed. I began the treatment by palpating and massaging the area of pain for a few
minutes and then I used the plum-blossom needle on the painful spots to relieve pain and let
some blood and pressure out. Then I used fire cups for suction. To my astonishment, after
removing the cups, there was not the usual appearance of bright red or darker red blood on the
surface. There appeared some very congealed, sticky, light red heaps of what looked like fat.
I removed it by wiping it off and massaged the area and surroundings with some eucalyptus,
winter green, and mint oils medicated salve. The whole procedure did not take longer than 15
minutes and patient was very satisfied with treatment as it gave him 60% pain relief and a better
range of motion. We repeated the same treatment the following week, and the patient reported no
more pain after that. For the whiplash patient, I performed the same 15-minute procedure of
palpating and massaging the affected area, used the plum blossom needle to access bloodletting
by applying the fire suction cups. This patient’s drawn blood was not liquid like bright or dark
red either, but rather congealed piles of dark fatty substance. The patient reported significant pain
relief and improved range of motion.
I learned that acupuncture treatment does not always have to last 40-60 minutes for the best
results. And for acute pain cases, when the cause of the pain is obvious, patients appreciate the
immediate and quick pain relief after the treatment. I wanted to learn more about what my
patients had been experiencing and found the following information:
According to the 2005 study by Erqing, Haiying, Zhankao, the acute articular soft tissue injury, a
frequently encountered disease, is often clinically treated with analgesics, Chinese drugs for
relaxing muscles and tendons to promote blood circulation, physiotherapy and acupuncture.
These therapies can achieve certain curative effects, however, there is a longer course of
treatment. The therapeutic method of bloodletting puncture with plum-blossom needle and
cupping is adopted to treat this disease with satisfactory therapeutic effect. As the plum-blossom
needle is used to tap the central point of the painful area and its surrounding area until bleeding,
which is followed by cupping at the bleeding place for 10-15 minutes. It results in disappearance
of pain with recovered free movement of joints and elimination of local swelling, and alleviated
pain with less restricted movement of joints and subsidence of local swelling. TCM holds that
pain is caused by local stagnation of qi and blood and obstruction of channels and collaterals.
Bloodletting puncture is able to promote the smooth circulation of qi and blood so as to stop
pain. This therapeutic method is convenient, cheap and effective, applicable to grass-roots clinics
and hospital. Bloodletting puncture with plum-blossom needle and cupping is effective in
treating acute articular soft tissue injury and its therapeutic effect is probably brought about
through accelerating blood circulation, promoting elimination of swelling and inflammatory
substances, alleviating inflammatory reaction and relieving spasm of muscles and ligaments as
well. (p.105)
In conclusion, Chinese medicine reminds me every day of its wisdom, simplicity and
complexity. Chinese medicine offers many avenues to practice the medicine with various tools,
and sometimes the simplest, shortest therapy may produce the most effective treatment, just as
the plum-blossom needle and cupping did for my two patients. It may not be revolutionary
treatment strategy for others, but this was definitely my clinical pearl.
Heat Therapy
Injury?
No Ice, Thank You.! Yes Heat, Please!
The purpose of writing this article for publication is to broaden the general public’ and medical
professionals’ views on using heat therapy for acute injuries rather than ice. My patients and a
recent article in Men’s Health Journal encouraged me to elaborate on this topic.
First, I will explain some of the history around ice therapy and heat therapy, and after I will
present the conflicting research surrounding the topic.
To ensure there is no confusion around what an acute injury is, here is a list of some examples: a
sprained ankle, frozen shoulder, falling and bruising, tennis elbow, abdominal cramps due to
eating cold foods and drinking iced beverages, stiffness from lack of physical activity, neck
muscle tension due to a pulled muscle, tired and overused muscles from prolonged physical
activity, as well as recovery from surgery and scaring.
First, I would like you to ask yourself how many times in a week, a month, a year, or a life time
have you injured yourself and applied ice to the injury, were given a suggestion to do so, or
someone else cared for you with an ice pack in their hands?
Also, ask yourself how often have you offered help in an acute injury situation by reaching out
for anything cold or frozen to apply to the site of injury?
According to an article in Men’s’ Health it’s been 50-plus years since Los Angeles Dodgers’
pitching legend Sandy Koufax first appeared in a 1965 Sports Illustrated photograph with his left
arm submerged in a vast of ice, an iconic moment in sports. Since then, no piece of published,
peer-reviewed research has shown definitively that ice is beneficial to the healing process. The
same article further educates us on another historical event: In 1978, orthopedic surgeon Dr.Mirkin, proposed the acronym RICE (rest, ice, compress, elevate) as a guideline for acute injury
treatment. And just like that without questioning, without any research supporting the health
benefits of icing injuries, let alone without any peer- reviewed studies, icing for injuries became
the norm. This has now been used among practitioners in the medical field for the past 47 years.
According to the same article, the risk of ice application on the human body includes the findings
that topical cooling delays recovery from eccentric exercise-induced muscle damage which then
results in the narrowing of blood vessels and in the restriction of blood flow which can kill
otherwise healthy tissue. Also, lymphatic vessels become more permeable causing a backflow of
fluid in the interstitial space and the local swelling at an injury will increase. The repetitive
application of ice to injuries will continue to damage the healthy tissues and delay the healing
process to the injury itself.
In simpler terms, what the icing method does is block natural human messaging system to the
brain. As soon as one removes the ice and the body begins adjusting to the warmer temperature,
the pain comes back. Is it good then? Who wants to kill the messenger? And why? Nevertheless,
this method found its audience, and it has been applied into medical practice to treat acute injury
since then.
The anecdotal part about the 47 years long practice of icing is that the very same surgeon and
licensed podiatrist Dr. Mirkin, now being 78 years old, advises against RICE and icing and
publicly admits being wrong. According to Men’s Health he even wrote a forward to G. Reinl’s
contradictory book on icing and resting in 2013: “Ice, The Illusionary Treatment Option”.
“As far back as 1986, a study published in the journal of Sport Medicine showed that when ice is
applied for a prolonged period, lymphatic vessels become more permeable, causing a backflowof fluid into interstitial space. That means local swelling at an injury site will increase, not
decrease, with the use of ice.
Live Well Live Long discusses many studies which report that icing reduces the flow of anti-
inflammatory healing cells to the injured site, delaying recovery and increasing signs of muscle
damage. (p.46)
Examples of some published studies advocating against ice treatment and promoting warm
treatments together with massages and acupuncture are collected from The Men’s Health article:
• 2010 a study in the Federation of American Societies for Experimental Biology Journal
• 2013 study in the Journal of Strength and Conditioning Research
• 2015 article in Knee Surgery, Sports Traumatology, Arthroscopy
• 1999 study in the Journal of the American Academy of Orthopedic Surgeons
• 1986 a study in the Sport Medicine journal
The book Live Well Live Long explains how the gold standard approach to injuries in
conventional medicine known as RICE has always been controversial from the Chinese medicine
point of view: The appropriate response to stagnation (blockages of flow due to injury) is
treatment which promotes flow, and not the one that congeals and contracts (ice), or which even
worsens stagnation (immobility). (p.47)
A couple new acronyms to replace RICE have been suggested:
1. MCE (Move safely when you can as much as you can, Compress and Elevate) Live Well
Live Long (p.48)
2. METH (Movement, Elevation, Traction, Heat) created in 2011 by a Canadian exercise
physiologist. (Men’s Health)And now, after investigating some history of icing practices for injury, let’s investigate the
history and benefits of warm/heat therapy. According to the Chinese Acupuncture and
Moxibustion book, hot water compression practices has been used in Asia during cold weather to
warm up stagnated body parts and promote circulation. (p.2)
According to Live Well Live Long, in Chinese medicine the response to injury is treatment that
restores the proper flow of qi and blood. Interestingly, many of the following treatments came
from the martial arts tradition where injuries were common, and teachers were expected to be
able to treat them effectively. Liniments containing warming and blood-moving herbs may be
massaged into or around the injury, and if immobilization is required, pastes of similar herbs can
be wrapped around the area before a splint is applied. Splinting allows some degree of movement
and is often preferred to more rigid plaster casts. Exercise to strengthen and improve qi and
blood flow is started at the earliest possible opportunity; even if it is only gentle mobilization.
(p.47)
More recent studies and publications present their results on the benefits of heat therapy for
injuries using various heat sources:
• The Turning up the heat study conducted in Great Britain suggests hot water immersion
(HWI) as a form of heat therapy which is anecdotally reported to be used by athletes.
Acute physiological responses can be manipulated by HWI to enhance recovery during a
training program, and the HWI-associated benefits to training enabled small but
worthwhile enhancements in strength adaptations following a resistance training
program. The main findings demonstrated that HWI is a viable means of heat therapy that
can support a greater intramuscular temperature following resistance exercise. This
research provides the first evidence which suggests a 'real world' HWI protocol canmaintain an elevated intramuscular temperature and blood flow following resistance
exercise.
• A study in Pain Research & Management found that the newly developed HIPER-500®
for high-frequency deep heat therapy showed positive effects for relieving pain and
improving physical performance in the patients of this study. HIPER-500® may be a
useful modality for treating shoulder pain and improving physical activity in patients with
shoulder disease.
• Based on the article in Men’s Health, in Canada, the United Kingdom, and Korea there
are books and articles published by physical therapists and exercise physiologists to
support the heat therapy approach to heal injuries.
• From my own investigation on you tube, there are still many videos preaching the “ice
way” without explaining the body’s reaction to ice application. On the other hand, there
are also videos available that explain in great detail the body’s responses to warm/heat
therapy for injuries, for instance: Manu Kalia, physical therapist, exercise science and
Ayurveda herbs practitioner in San Francisco Bay Area educates us in Stop using ice bad
for healing injuries.
And why do I emphasize the importance of proper healing for even the small injury or bruise?
According to Live Well Live Long, Chinese medicine teaches that even relatively minor injuries
can have aftereffects, some of which may not reveal themselves until years later in the form of
osteoarthritis, chronic pain, numbness or weakness. The reason for is the immediate consequence
of the injury, which is an obstruction of the normal flow of qi and blood, manifesting as pain,bruising and tissue damage. The healing process requires restoration of flow, and failure to fully
heal can manifest in two main ways:
1. Residual stagnation and accumulation settle at the injury site and give rise to continuing
pain which can become chronic.
2. Although the immediate stagnation may resolve, there remains an underlying weakness in
the flow of qi and blood at the injury site. This may not show any symptoms for a long
period of time, but with aging the weak area will start to cause a problem, such
rheumatism and arthritis. A recent discovery from a 2011 study reported that over 40% of
people who suffer ligament or meniscus tears will eventually develop osteoarthritis in
that location, and 12% of all patients with lower extremity osteoarthritis have a history of
joint injury. (p.47)
In my practice I treat my injured patients often and explain to them the reasons why I do not
approve on using ice on an acute injury, and why I treat injuries and pain with a TDP* lamp,
moxa* ointments and heat packs, in addition to acupuncture. After this treatment which warms
and promotes circulation, all my patients experience the benefits of heat therapy and they
understand the healing approach to their injuries because of the immediate pain relief and
increased flexibility within 45 -60 minutes of treatment.
In conclusion, many peer- reviewed research studies show that ice delays healing and recovery,
and only stops the pain receptors reaching the brain temporarily. On the other hand, both ancient
medicine (Chinese medicine, Ayurveda medicine) and recent peer-reviewed research explains
and proves the healing properties and benefits to the site of injury using heat. By summarizingthe history, the pros and cons of the ice and heat approaches to healing acute injuries, I would
like to encourage patients to look outside the box to address their injuries.
Note:
*TDP lamp (Teding Diancibo Pu) is a special electromagnetic spectrum lamp. This type of light
therapy is best for pain, stiffness, and muscle spasms. The ionized plate heats up and emits
invisible, infrared light that penetrates up to 3 inches into the skin and can increase circulation to
areas of pain and stiffness.
* moxa ointments are blends of herbs and oils used for swelling, strain, sprain, musculoskeletal
injury and arthritis.
Bio:
Jarmila Sevcikova L.Ac., has been practicing traditional Chinese medicine in the Chicagoland
area since 2013. She is a licensed acupuncturist and a doctorate candidate, currently enrolled in
transitional doctorate program in Pacific College of Health and Sciences in San Diego,
California.Reference:
Deadman, P. (2016). Live Well Live Long. Hove BN33EB: The Journal of Chinese Medicine Ltd.
Gi-Wook,K.,Yu Hui,W., Sung-Hee, P.,Seo, Jeong-Hwan; Kim, Dae-hyun; Hyung Nam,
L.,Myoung-Hwan, K. Pain Research & Management (2019) p.9 Effects of a Newly
Developed Therapeutic Deep Heating Device Using High Frequency in Patients with
Shoulder Pain and Disability: A Pilot Study.
Jackman, J. (2019), Tunning up the heat: Can post exercise hot water immersion be used to
manipulate acute physiological responses and chronic adaptation following resistance
training? Middle Essex University, British Library. Retrieved from:
https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.785711?
Kalia, M. (September 2012). Stop using ice bad for healing injuries. Retrieved from:
https://www.youtube.com/watch?v=aPkO4niu7vg
Liangyue,D. ,Yijun,G., Shuhui,H., Xiaoping,J., Yang,L., Rufen,W., Wenjing,W., Xuetai,W.,
Hengze,X., Xiuling, X., Jiuling, Y. (1999). Chinese Acupuncture and Moxibuston.
Beijing,China: Foreign Languages Press.