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Bloodletting by PhysicianIf you have injured yourself to the point it will likely swell most of us fall to the doctor recommended RICE technique: Rest, Ice, Compress, Elevate. Though it works fine, today we’re going to simply add a few things to the therapy, which will aid in the healing but will not spell an easy recall acronym, so you will simply have to find another way to remember. Anyway, sticking a big ‘ole “B” for bloodletting into the mix, wouldn’t really spell anything worthwhile, and might just confuse matters. We’ll start a little more nice….

Ice is great for reducing inflammation it’s just that sometimes people either don’t use it soon enough after the injury, and the swelling has already happened and/or most use it for too long after. While one to two days should be adequate, during the initial recovery phase you can apply ice after activity if the effected area gets irritated (which usually means you shouldn’t be using it strenuously yet) or preferably in hydrotherapy types of treatments where you alter hot and cold to stimulate healing to the area. Ultimately you will have to use your best judgment. Though simply relying on ice alone for extended periods keeps the muscles stiff and slows down the body’s natural healing process. Initially it keeps the blood from moving into and reduces pain and swelling of the area but the downside is that it also keeps the oxygen and nutrients from moving in and the Anatomical Bloodlettingacids and waste from moving out. Scar tissue forms and overall it seems to take a longer time to repair with full function.

Followers of ancient healing traditions believe there is never good reason for using ice on an injury. The other side counters that these traditionalists are just following ideas based on “the olden days” when ice was more difficult to procure and therefore not a readily available option. Traditional Chinese Medicine World (www.tcmworld.org) elaborates on the wisdom behind the no-ice theory:

Any kind of injury…involves blood stagnation. In order to help the blood flow you need to increase the flow of energy (Qi), so acupuncture and herbs are used for treatment. Most important, don’t use ice! In the martial arts, most of the time ice is not used; heat is used on sports injuries. Ice will keep everything in the area frozen, making the circulation worse. The use of ice can cause arthritis later on. In the short term, using ice may be better than heat because you will feel immediate relief from the pain, but good treatment—good acupuncture, good acupressure—is much more effective than ice because it treats the root cause of the problem.”matsu

Although the RICE technique is typically utilized for accident related injuries, as opposed to muscle over-exertion, there are similarities in treatment. And it’s interesting to look at how ice is used as therapy to better understand its usefulness. Lots of athletes like to overdo the ice, so they can numb an area and “get back in the ring” so to speak. And despite the traditional teachings, even many martial arts organizations utilize ice and topical “icy hot” sprays these days to better compete during tournaments. But many sports are starting to reevaluate the procedures. For example, there has been some debate recently over whether the Red Sox’ new million dollar wonder, Japanese pitcher Matsuzaka, ices his arm after the games; it seems he has been seen doing so on rare occasion, but does not rely on it like American players do. People are starting to wonder, could that have something to do with his “superhuman” ability to throw longer, harder, faster and finish more games than most American pitchers? Dick Mills on his blog The Baseball Pitching Rebel has been writing about baseball pitcher’s “ice abuse” problem for years now. Finally he has a tangible source to offer his readership. A 2006 study by Howatson, G., van Someren, D. A., Hortobagyi, T. very clearly concludes, “Ice massage [is] ineffective in promoting muscle function recovery following exercise-induced muscle damage.” “Pitchers,” Dick insists, “would be better off to do some running [or swimming] for twenty minutes or so while keeping their arms moving to aid flushing the waste products that build up around the joints after pitching.” He goes on to add that despite some slowly evolving protocol most ignore the recent findings. “So why do major league pitchers [continue to] wrap their arms in ice after games?” he deliberates. “Because they ‘believe’ it works. It appears that icing after games works about as well to aid performance and reduce injury as eating a favorite food before a game. It’s mostly superstition.”

In a sport that has a comparable rate of injury and surgery to the NFL, gymnasts are often berated into continuing their training despite over-exertion, lack of sustenance and even broken bones. They rely on heavy doses of anti-inflammatory drugs and ice baths to essentially help them to ignore the problems. The goal of and result of an ice bath is not healing, but to get them through the competition – to get them to Olympic Gold. Quick cure vs. real cure. For these athletes, unfortunately, their ill-health, pain and physical disabilities will be dealt with…later (likely for the rest of their lives.)

Personally I have found a way that seems to utilize the benefits of both RICE and TCM theory after an injury – take away the pain and inflammation and also stimulate the body to heal quickly. The element I add is based on the Theory of Counteractivity. I looked online for anything on the subject, which I learned about years ago from a book by Arya Nielsen entitled Gua Sha: A Traditional Technique for Modern Practice (my copy is presently in storage.) Even in the beta “Scholarly” Google Search Engine this “Theory” is not to be found and possibly goes under some other scientific names so, since it’s pretty simple, we’ll do the layman summarization.

med006b-saved-the-foot.jpgThis is how I like to equate it (runs kinda parallel to the idea that “Things can always get worse” – sounds negative but we’ll try to turn it into a positive.) Imagine, you have a hangnail, and it’s driving you crazy. Where are your nail clippers! You’re in bed and it’s brushing against the sheets as you try to fall asleep, or gets snagged as you put your sock on in the morning. It bothers you until…Damn! You bang your knee on the coffee table, and it friggin’ hurts – you’re dizzy even. You no longer notice or care about your hangnail. Your knee is starting to swell. You know what the best cure for that is? Well, one can only assume a bullet to the chest will give your mind and body more important issues to fixate upon. Okay, quite superfluous, but that’s the basic idea. Oh, and what was the “positive” – well, that your hangnail no longer bothers you. Physiologically speaking, the body will focus on the greater issue at hand, the more minor issues become secondary. On top of that, the body’s priority is to focus first and foremost on areas closest to the heart. The torso, with all those major organs, is the priority, and after that comes one’s head and then limbs (i.e. you can survive without your legs or arms, and we see many a “brain dead” person live on, but you’re pretty worthless without a torso).

How does this play into treatment of injury? Well, instead of waiting for chance and circumstance, you can cause such an incident. Create a new irritation that is above the injury so the body will focus on it instead. If there is an infection or swelling at the site of your original injury, you could do something that brings the body’s attention to another area and essentially stop the blood from pooling and stagnating at the site. How can this be done? Let’s first look historically….

In the last few years there has been some discussion in the scientific community about why bloodletting may have actually worked. It mainly focuses on lack of antibiotics during the time in history in which it was prevalent and bacteria such as Staphylococcus aureus or simply “staph” which needed “heme iron” found in blood to survive. Bloodletting decreased the iron it needed and therefore could realistically prevent the bacteria from thriving. (Who knows, maybe when these bacteria eventually become “immune” to all of our antibiotics, as seems to be happening with Staph and certain “flesh-eating bacteria”, we could find renewed hope in old methods).

But there is another aspect to bloodletting which is less often discussed yet is well-documented. This historic therapy supposedly began 3000 years ago with the Egyptians (though who knows exactly when the Mayans first began utilizing obsidian blades and stingray spines [granted their use was possibly skewed towards ritual and sacrifice (we'll have to ask Mayan expert Mel Gibson and hope he doesn't yell profanities if we disagree)], and the discovery of ancient bian stone in China has provided powerful evidence that acupuncture/bloodletting originated early in that primitive society’s late New Stone Age). Bloodletting had its heyday in the 19th Century, ultimately becoming the foundation of modern medicine and surgery, yet today it is commonly discarded as archaic quackery. Many people don’t realize bloodletting was still utilized as a common treatment not very long ago, and that versions of it exist today, throughout the world. But perhaps some of the confusion (and outright disdain for the treatment) stems from lack of knowledge regarded its benefits and the different versions of the technique. There was General bloodletting, which includes venesection and arteriotomy (you know, slice a vein or artery and let it flow) and local bloodletting, which includes leeches and scarification with wet cupping (there is also dry cupping and therapies of a similar nature which imitate the action by simply drawing blood to the surface of the skin).instruments

In his article “Bloodletting Over the Centuries” (New York State Journal of Medicine, December, 1980) author Gilbert R. Seigworth, M.D. discusses the concept of this “localized bloodletting”:

Cupping may be wet or dry. Dry cupping is the application of a suction cup over an area of intact skin. The idea was to draw underlying blood and fluid away from the area of inflammation to the surface of the skin. This method relieved the congestion from the inflamed area, but did not remove fluid from the body…. Wet cupping involved scarification of the skin so that blood and fluid could be extracted. … Bloodletting counteracted the redness, heat, and swelling by relieving the vascular congestion.

Though the original hypothesis was that bloodletting would release evil spirits from the body via the blood and balance the “humors”, later it was used to cure nervous disorders, hypertension, and relieve abscess and swelling. The following quotation from Watson and Condie’s Practice of Physic (1858) gives more insight to the premise:

The main object of general blood letting is to diminish the whole quantity of blood in the system, and thus to lessen the force of the heart’s action. The object of local bleeding is, in most instances, that of emptying the gorged and loaded capillaries of the inflamed part. Sometimes the blood is thus taken directly from the turgid vessels themselves; more often, I fancy, topical bloodletting produces its effect by diverting the flow of blood from the affected part, and giving it a new direction, and so indirectly relieving the inflammatory congestion.

There was logic to the treatment, even though the hypothesis on which it was based might have been incorrect. And it seems inappropriate to discard the whole therapy when proper use of certain techniques can induce beneficial effects. And though there have been obvious influences of Western Medicine upon modern East Asian Medicine, you can still find acupuncturists who utilize the benefits of bloodletting in their therapy. Skya Abbate, executive director of Southwest Acupuncture College in Santa Fe, New Mexico writes in her Acupuncture Today article “Bleeding Techniques: Ancient Treatments for Acupuncture Physicians” (2003):

An ancient Chinese treatment technique that … the modern-day practitioner may be hesitant to use in his or her treatment plan is bloodletting. Perhaps there is reluctance to use this method due to the drawing of blood, which can transmit blood-borne pathogens; there may also be some concern about causing the patient potential discomfort. However, bleeding is a specialized technique for specific conditions that can produce effective and dramatic results when the patient’s condition is diagnosed properly and the bleeding method expertly executed.

For this technique regular acupuncture needles and lancets are used. But typically today acupuncturists utilize cupping and needling (without the deliberate bleeding) to create a similar affect. My favorite of this category though is the non-invasive, simple, easy to learn, overwhelmingly efficient aforementioned Gua Sha (pronounced gwa saw). Gua Sha is another Asian healing method, and so common a home remedy it’s like Chicken Soup, going by a number different names around the world (including Cao Yio, Kerik, Khoud Lam and Coin Rubbing). The idea is that you’re pulling the cold (wind) out of the muscles, bringing blood to the surface, increase circulation and allow whatever was stuck in the contracted muscles to leave through the blood. An excerpt of Arya’s book:

Gua Sha involves palpation and cutaneous stimulation where the skin is pressured, in strokes, by a round-edged instrument; that results in the appearance of small red petechiae called ‘sha’, that will fade in 2 to 3 days. Raising Sha removes blood stagnation considered pathogenic, promoting normal circulation and metabolic processes. The patient experiences immediate relief from pain, stiffness, fever, chill, cough, nausea, and so on. Gua Sha is valuable in the prevention and treatment of acute infectious illness, upper respiratory and digestive problems, and many other acute or chronic disorders.

whatis_r2_c2_f3.gifGua Sha not only has the benefits of removing blood stagnation but it also draws attention from other areas to it. The idea being that instead of needing to utilize the bloody bloodletting to distract areas from congesting and swelling and encourage the body’s blood to flow and injuries to heal, we have options that use other techniques with similarly positive results.

But ultimately, when we get down to it, the most difficult thing is taking care of ourselves after we get hurt. I mean, we’re hurt for cryin’ out loud! So in order to more easily tend to our own injuries or those of our loved ones: we need to keep it simple. I have come up with a solution that is easy to explain to someone, but depending upon one’s conditions, can be just as easy to do for oneself. The idea again is to create a simple “counteraction” that will cause your body to pay attention to and bring blood into an area other than and just above the injury, which we will assume is starting to swell. The answer? Heat! Well, more specifically it’s the combination of cold and heat at the same time. The ice pack goes on the injury itself, while the heat, creating the counteraction, goes about six inches above it. I know it sounds simple, perhaps too obvious…it is! Now the only acronym that I could come up with for RICE + H (heat) is CHERI. Well, I guess it makes about enough sense as RICE. Or how about this? You take a clean cotton tube sock, fill it with uncooked rice and knot up the open end. Then if you get injured, you stick this sock in the microwave for a couple minutes and there’s the heat portion of your RICE therapy made with rice.

So now that you understand the theory behind it we can tie this all together….the more in-depth but still easy steps to best heal an injury:

#1) Immediately use ice (if it’s an open wound and/or there is bleeding, tend to that first. Use gauze if needed to protect from ice or I prefer a soft ice pack.) Keep area elevated; apply compression.

#2) Take homeopathic arnica pills if available (advisable to keep in every emergency kit and in purse). Topically apply arnica gel if there’s no open wound.

#3) Place a heat pack on the area just above your injury. Use either the kind you can boil to heat, an electric moist heat pad (if you can, invest in a Thermophore – just not the one with the automatic switch cause those are junk), or use the disposable Therma-Care [Costco has the best price] or Moxa [any variety if you know how – or try the new Moxa patches...and let me know if they're good!]). This heat should be “counteraction” enough, but if not you can have someone punch you somewhere above the wound…or if you happen to have a bottle of leeches try those). Seriously though, finger pressure, pinching or any other irritating gesture could add to the distracting effect of the heat. And actually, if you are tough, by using the application of heat you might be able to avoid the ice altogether. Note: If a hematoma is forming just above your injury, put the heat above the hematoma.

#4) If you have access to acupuncture, acupressure, reflexology, lymphatic massage, cupping or gua sha – take advantage! If not, keep your blood flowing somehow. Little toe point-and-flex or ankle rotations can bring circulation through the legs for example (as long as it doesn’t do more damage, as perhaps with a torn ligament). Or get someone who loves you enough to rub your feet, hands, whatever needs da rubbin’. We’ll get into the benefits of noni some other time.

#5) Try to avoid those pain killers. You’re just going to feel it more the next day, and have to take more drugs. If you need to, pop an Advil or something that brings down swelling. But if you can handle, have someone get you a nice quality “no sulfites added”, organic red wine and sip a glass before going to bed.

#6) As you are improving use hydrotherapy (hot and cold therapies) and speed up the healing time. These can be dunks, plunges, or with hot and cold packs (caution to diabetics).

#7) Discover ways in which you can strengthen your body, it terms of nutrition, balancing of one’s yin/yang, building muscles to help stabilize the weakened area.

Hey, that’s it. Congratulations. Be safe, be prepared, and I hope you don’t get to try it out too soon.

Note: This article is obviously not meant to replace the advice of your physician. These are opinions and should be read with caution and at own risk, etc. Bloodletting is best done by a professional. ;) Ultimately the best medicine believes first and foremost there is a reason for every injury, and that often (even in cases of accidents) the area injured is already deficient or there is poor blood/energy flow which makes one more susceptible – creating a weak spot in one’s invisible protective forcefield. As I am utilizing my heat and ice as we speak, with time to mull while recovering from the after-effects of a strangely torqued knee after trying (and painfully succeeding) to stall in the barrel of a nice glassy wave, I have reason to believe it true. Anyway, the idea here is that there are many ways to find relief from pain or panacea to avoid the root cause of one’s afflictions. But the ultimate cure comes from within, beginning with an awareness that there is more behind the injury then the injury itself. It is only when we tune into the higher essence that we can find balance and become truly whole. Yeah, well, in the meantime… I’ll just write about it.

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