Traditional Chinese Medicine (TCM) Discussion

A teenager in northwest China’s Xinjiang Uygur Autonomous Region died of A/H1N1 influenza Tuesday, after at least eight Chinese nationals had fallen victims to the virus on the mainland.
The 14-year-old school student surnamed Guo, of Fuyun County in Altay Prefecture, was treated at local clinics for a fever on Oct.30. He was transferred to the Fuyun People’s Hospital Tuesday, but later died, said the regional health department.

Tests on Wednesday showed Guo died of A/H1N1, viral pneumonia and acute respiratory distress syndrome, the department said.

Eight deaths from A/H1N1 had earlier been reported from Beijing, Tibet, Qinghai, Xinjiang, Heilongjiang, Guangxi, Hunan and Zhejiang.

In the eighth case, a 60-year-old man in Ningbo City, Zhejiang Province, died Tuesday as he was recovering from the flu two days after tests showed negative.

“The flu also worsened his heart disease, high blood pressure and chronic bronchitis which directly caused the death,” said Ma Weihang, deputy head of Zhejiang Provincial Health Department.

A 32-year-old Russian man died of the virus in Beijing Monday. He arrived from Russia on Oct. 28 by air and went to hospital on Sunday with severe breathing difficulties and other symptoms.
(Xinhua)

The Chinese mainland is seeing an increasing number of cases of the A/H1N1 flu. So far, 8 people died after contracting the virus. Many public sectors around the country are doing their best to combat the growing threat.

In Beijing, subway workers have been disinfecting facilities five times a day. And ventilation systems at newly built subway lines are working through the night. Each train is disinfected at least once a day.

In Sichuan province, people are receiving the vaccine, including many areas that were affected by last year’s earthquake.

In the municipality of Chongqing, health sectors are supplying 2 tons of traditional Chinese medicine for residents. All are free of charge.

In Shandong province, health officials have offered tips to combat the flu.

Yang Hong, Dietician of Qingdao Haici Hospital, said, “Stewed mutton is not only delicious, but can also keep out the cold and increase people’s resistance to diseases. Eating more fish, meat, eggs and milk, and boiling vinegar for disinfection, are all effective ways of preventing transmission.”

In Guangxi Zhuang Autonomous region, department stores have stopped their central air-conditioners. They have turned on electric fans and are opening more windows and doors to keep fresh air circulating.

People are also coming up with their own ways to protect themselves against the virus.

A resident said, “We often wash our hands as well as the children’s. It’s not terrible.”

In southwestern Yunnan province, the local disease control center has strengthened quarantine and inspection measures at border checkpoints. It has printed health declaration cards and informative materials in various languages for the convenience of people entering the country.

Yahoo Malaysia news reported that doctors at Ditan Hospital in Beijing claimed that a combination of various Chinese herbs had a 75 percent cure rate in the 117 patients treated there for swine flu.

http://malaysia.news.yahoo.com/bnm/20090723/tts-flu-herbs-993ba14.html

The government had allocated 10 million yuan (about $1.5 milliom US) to research treatment of swine flu using traditional Chinese medicine, including one study comparing results with Tamiflu treatment.

Doctors at Ditan Hospital first stared treating all patients with the antiviral drug, Tamiflu plus the herbal combination, but discontinued the Tamiflu for the non-critical patients within a month after determining that the herbal medication was effective by itself.

In the article, hospital spokesman Dr. Wang Yuguang, deputy dean of the Centre of Integrated Traditional and Western Medicine was quoted: “From our clinical tests and observation, the traditional method of treatment left no after effects and it is safe.” He added that the recovery period was shorter than in patients who received Tamiflu and the daily cost of the herbal remedy at about 12 yuan ($1.76 US) was lower as compared to Tamiflu treatment at 56 yuan ($8.20 US),

Wang would not reveal the actual herbs used, stating that the advantage of traditional Chinese medicine is that doctors can gear their herbal prescriptions to the specific patient’s condition. In his news briefing, he claimed that doctors at the hospital had recently used this approach with high-risk patients with good results. Given these findings, the Chinese government has apparently advised hospitals to use traditional treatment as a first line approach and resort to Western medicine only after Chinese medicine fails.

In the meantime, while 11 Chinese companies work on developing a swine flu vaccine to prevent the disease, Beijing Traditional Chinese Medicine Hospital has introduced an A/H1N1 swine flu prevention herbal medicine pack which, according to Jin Wei, Deputy Director of the hospital, contains seven small packs of four types of herbs in combination and taken mixed with hot water as a tea or used as mouthwash. Jin Wei said the pack could even cure mild cases of swine flu, but that if patients did not recover after taking the herbs for seven days, they were advised to go to the hospital for further treatment.

According to the news article, the combination of the herbs is as follows:

Lonicera Japonica Thund (honeysuckle flower)-3 grams,
Isatis Indigodica- 3 gms,
Mentha Haplocalyx Brip (mint).-3 gms
Glycyrrhiza Glabra(licorice)-3 gms.

These herbs are available in Chinese herbal medicine shops. It should be noted that a search of the scientific literature, the web and discussions with infectious disease colleagues did not produce a primary source for these claims, so the herbs and their doses reported in the news article may or may not be accurate.

What are these herbs and what do they purport to do?

Lonicera
Laboratory investigations of lonicera have mainly focused on demonstrating anti-inflammatory actions. In vitro and animal studies indicate antibacterial and antiviral activity (mainly tested for seasonal influenza). In traditional Chinese medicine it is used almost exclusively for prevention and treatment of the common cold and upper respiratory tract infections, sore throats and general flu-like symptoms

Isatis
Also known as Woad root, this herb is thought to have very broad anti-infection properties, which partly explains its repeated use in these formulas. It contains the dye indigo (a crude form is used as the Chinese medicinal substance qingdai), which has been used worldwide as an antimicrobial medicine.

Mentha
These are Chinese peppermints and were described by the Chinese as early as 470 AD in the Oriental Materia Medica as a treatment for fever, headaches, excessive tearing, sore throat, oral and skin lesions, rash, and toothache. The principal active constituents of mentha are the essential oils, which comprise about 1% of the herb. They dilate peripheral blood vessels, inducing perspiration and alleviating aching.

Glycyrrhiza Glabra (European licorice)
Therapeutic use of licorice dates back to the Roman Empire. Hippocrates (460BC) extolled its use as an expectorant and gas reliever. It is one of the most commonly used herbs in the Chinese Materia Medica and is traditionally said to “harmonize” a formula in Chinese medicine, acting as a guide drug to enhance the activity of other ingredients, reducing toxicity, as well as improving flavor. In Western medicine it is commonly found in cough medicines. Recognized side effects of prolonged use includes hypertension, water retention, sodium retention and loss of potassium.

The theory in traditional Chinese medicine is that rather than using a single herb or a single formulation to treat an infection like flu, a collection of herbs and formulas working together will produce a better response in the patient. Many of these formulations evaluated in large scale studies in China from the 1950s through the 1970s claimed to demonstrate preventive properties. These findings, which appeared in Chinese medical journals and books, were reviewed at the Institute for Traditional Medicine (ITM) in Oregon. In a 2006 report, Subhuti Dharmananda, PhD, Director of ITM, explained that “while there is insufficient proof from these studies that Chinese herbal therapies can cure or impede influenza because of problems in methodology and reporting, practitioners of Chinese medicine and their patients are convinced of the efficacy of this approach.”

Routine prescription of Chinese herbs for seasonal flu or other therapeutic applications continues to be limited primarily to those countries like China, Japan and Korea where traditional herbal medicine is officially recognized. In other countries, including the US, herbs are available mainly through the work of licensed acupuncturists, naturopaths, and other non-M.D. practitioners, as well as through direct marketing of products to consumers.

Although Chinese research has recently been tainted by allegations of widespread fraud,
there is clearly much to be learned from the potential use of herbs to treat various diseases including swine flu. As Americans turn more and more to alternative medicine, it will be critical to have good scientific data to document the safety and efficacy of herbal formulations. It is important to remember that herbs, though “natural” often have strong medicinal properties that may include dangerous side effects.
- Deborah Shlian Miami Health Care Examiner

By Dr. Marina Ponton

Sixty years ago, when China faced a health-care crisis fueled by too many people to treat, too little money and too few doctors to provide care, the Eastern Asian country embraced its past, turning to acupuncture and Oriental medicine for answers.
Between 1949 and 1978, the average life expectancy in China increased from 35 to 68 years. Today, Traditional Chinese Medicine is a major component of China’s health-care delivery system where doctors are trained in the traditional methods of acupuncture and massage, as well as the diagnostic and surgical techniques of Western medicine. Treatments such as acupuncture, herb therapy and massage therapy account for around 40 percent of all health care delivered in China.

I’m aware that Traditional Chinese Medicine (TCM) doesn’t match the scientific model of the U.S. health-care system, and that many view TCM as alternative “folk healing” that often is considered only after conventional treatment options have been exhausted. But with health-care costs in the U.S. continuing to escalate, more and more Americans are looking for alternative answers to their health-care needs, realizing that one-size-fits-all medicine isn’t working.

For three weeks this past June, I worked alongside health-care professionals at Chengdu University of Traditional Chinese Medicine in China’s Sichuan province. Founded in 1956, Chengdu University is among the oldest TCM universities in China, with a hospital that houses a 5,000-square-foot herbal pharmacy and seven floors of outpatient care. My time at Chengdu confirmed that a fully integrated health-care system that improves the quality of care while decreasing its cost is attainable and sustainable.

Traditional Chinese Medicine differs from Western medicine by emphasizing patient education and preventive care, and by teaching patients how to take personal responsibility for their own health and methods of treatment. Culturally, the Chinese are more aware of their health, with the average person in China entering a medical facility as a knowledgeable patient.

The basic premise of TCM is that a body in balance has a basic immunity to health issues. You truly are what you eat, think and breathe. You are the lifestyle you lead. That’s why overall, the Chinese are a healthier people. They are taught TCM techniques as children and practice them throughout their lives.

A great example is chronic childhood ear infections are non-existent in China. Children are given herbal formulas from day one, which prevent their development. Frankly, the idea of surgery to place tubes in a child’s ears or giving children antibiotics long term is considered primitive and uncivilized to Chinese doctors.

While there are people with difficult diseases in China, they tend to respond better to care. There are far fewer instances of death from cancer in China, and when a case is terminal, those patients tends to live longer and have a better quality of life in the final stages. While in China, I met several nine and 10-year survivors of pancreatic cancer.

Traditional Chinese Medicine has been providing an uninterrupted system of prevention and wellness worldwide for thousands of years. It makes primary health care more affordable because it provides effective treatments for chronic and acute conditions at a fraction of the cost of Western medicine. For example, Chinese women who are having surgeries and receiving chemo for breast cancer, at the same time, are getting IV drips of Chinese formulas to mitigate the side effects for nausea, dizziness and fatigue rather than taking another pharmaceutical drug.

The U.S. system of health care has handicapped doctors. It has created the current crisis of unmet needs, virtually no preventive care, and mounting costs that cannot be supported. Americans are forced to decide among the most expensive health-care services in the world, with most insurance plans offering no option to choose natural health modalities such as acupuncture, herbal medicine, massage, diet modifications, and breathing and movement therapies.

I have many patients whose insurance will not cover their natural health treatments. However these treatments often lessen the need for pharmaceutical drugs or costly surgeries, and in some cases, eliminates it. Costs are offsetting and often reduced.

A bill has been introduced in the U.S. House of Representatives that would add acupuncture as a benefit covered under both Medicare and the Federal Employees Health Benefits (FEHB) program. The Federal Acupuncture Coverage Act would be an excellent start to an integrated system of care that prevents and treats illness rather than symptoms and side effects.

The basic premise of TCM is that a body in balance has a basic immunity to health issues. You truly are what you eat, think and breathe. You are the lifestyle you lead. That’s why overall, the Chinese are a healthier people. They are taught TCM techniques as children and practice them throughout their lives.
A great example is chronic childhood ear infections are non-existent in China. Children are given herbal formulas from day one, which prevent their development. Frankly, the idea of surgery to place tubes in a child’s ears or giving children antibiotics long term is considered primitive and uncivilized to Chinese doctors.

While there are people with difficult diseases in China, they tend to respond better to care. There are far fewer instances of death from cancer in China, and when a case is terminal, those patients tends to live longer and have a better quality of life in the final stages. While in China, I met several nine and 10-year survivors of pancreatic cancer.

Traditional Chinese Medicine has been providing an uninterrupted system of prevention and wellness worldwide for thousands of years. It makes primary health care more affordable because it provides effective treatments for chronic and acute conditions at a fraction of the cost of Western medicine. For example, Chinese women who are having surgeries and receiving chemo for breast cancer, at the same time, are getting IV drips of Chinese formulas to mitigate the side effects for nausea, dizziness and fatigue rather than taking another pharmaceutical drug.

The U.S. system of health care has handicapped doctors. It has created the current crisis of unmet needs, virtually no preventive care, and mounting costs that cannot be supported. Americans are forced to decide among the most expensive health-care services in the world, with most insurance plans offering no option to choose natural health modalities such as acupuncture, herbal medicine, massage, diet modifications, and breathing and movement therapies.

I have many patients whose insurance will not cover their natural health treatments. However these treatments often lessen the need for pharmaceutical drugs or costly surgeries, and in some cases, eliminates it. Costs are offsetting and often reduced.

A bill has been introduced in the U.S. House of Representatives that would add acupuncture as a benefit covered under both Medicare and the Federal Employees Health Benefits (FEHB) program. The Federal Acupuncture Coverage Act would be an excellent start to an integrated system of care that prevents and treats illness rather than symptoms and side effects.

Dr. Marina Ponton is an acupuncture physician who has been in private practice since 1999. She opened Greenville Natural Health Center in Greenville in 2007. She can be reached at info@greenvillenaturalhealth.com.

A toad’s venom could become a new weapon in the battle against cancer.

The toxin – found on the amphibian’s skin – has long been used as a traditional Chinese medicine.

But now US researchers have tested the venom extract on patients with liver, lung, and pancreatic cancer.

A study published in the journal Cancer suggested the toxin can stop the growth of tumours and improve immune system function.

Scientists gave 15 patients with late-stage cancer daily doses for more than a year.

The disease remained stable in six patients for an average of six months and one patient had a 20% reduction in tumour.

Researchers are now carrying out further trials.

LOS ANGELES (MarketWatch) — Recent clinical trials in Beijing show traditional Chinese medicine is effective in preventing and curing the A/H1N1 virus, commonly known as “swine flu,” according to a report Thursday in Chinese state media.

The report cited the Beijing Municipal Health Bureau as saying traditional cures were validated by five months of research, prompting the city to reserve 2 million doses of the unspecified treatment.

“The Beijing municipal government has invested 10 million yuan ($1.4 million) to test the effectiveness and safety of [traditional Chinese medicine] to treat A/H1N1 flu since May,” the report quoted the city’s chief of traditional medicine Zhao Jing as saying.

Zhao said that as of Sept. 1, a total 326 of 845 confirmed cases of A/H1N1 in Beijing had been cured with traditional treatments, adding that such cures proved “very effective” in combination with Western medicine.

The report also quoted Wang Yuguang, a senior expert with Beijing Ditan Hospital, as saying: “Clinical tests have showed that [traditional medicine] doses help reduce symptoms of fever, sore throat and cough. … No side effects and adverse reactions have been reported.”

When Dr. Francis Yu started his acupuncture clinic in California in 1970s, most of his patients were Chinese. But now, half of his patients are non-Chinese.

“More non-Chinese Americans begin to accept the Chinese way of treatment, such as acupuncture, cupping and herbal medicine. Another truth is, at least in California, nearly half of those who have acupuncture licenses and operate acupuncture clinics are not Chinese but Americans who do not know Chinese,” said Yu who owns his two-storied TCM Healing Institute in Arcadia in the suburbs of Los Angeles.

Dr. Yu’s remarks echoed the recent press reports that alternative medicine is finding wider acceptance by doctors, insurers and hospitals in the US.

People turn to unconventional therapies and herbal remedies for everything from hot flashes and trouble sleeping to cancer and heart disease. They crave more “care” in their health care as more people distrust drug companies and the government.

California became the first US state to license qualified acupuncture practitioners as primary care providers in 1978. As of2004, California has licensed more than 9,000 acupuncturists. Now the figure is estimated to exceed 15,000. California constitutes nearly half of the licensed acupuncturists in the US.

Dr. Yu told Xinhua that in the early days, acupuncture was not accepted and respected by the mainstream. Most Americans did not regard acupuncture as alternative treatment. But as time goes by and when more US hospitals and research institutions set up acupuncture treatment centers, more Americans turned to the Chinese acupuncture and herbal medicine to cure diseases conventional American doctors could not treat.

He said recently one American lady on her 40s came from Florida to treat her pain on the neck. But Dr. Yu told her she needed to remove her plaque in her artery. She received cupping treatment for several times and when she went back to Florida, her doctor told her the plaque was gone and she felt much better.

She then recommended her friend, a 47-year-woman, to see Dr. Yuin the hope she can get pregnant. Dr. Yu said the treatment was going on, and he was not sure whether the lady could get pregnant at her age. But those cases show that more Americans are willing to try the Chinese way in medical treatment.

In California and other states, when a doctor has an acupuncture license, the doctor can give herbal treatment to the patients. Although traditional Chinese medicine is not legal in California, doctors with acupuncture licenses can treat patients with cupping and herbal medicine.

The legal use of herbal medicine was made possible 15 years ago when the US Congress decided to allow dietary and herbal supplements to be sold without Food and Drug Administration (FDA) approval. Since then the number of products soared, from about 4,000 then to well over 40,000 categories now.

The increasing acceptance of alternative treatment such as acupuncture and herbal medicine was also made possible by big healthcare insurances that cover expenses of patients who accept treatment of acupuncture, cupping and herbal medicine, Dr. Yu said.

Although Dr. Yu said the government regulation seemed ridiculous for doctors to have an acupuncture license first before they can practice other Chinese medicine such as cupping and herbal treatment, it legalizes the practice of acupuncture and other ways to treat patients in the Chinese way in the US.

Increasing numbers of big hospitals and institutions, including Johns Hopkins Hospital and the R Adams Cowley Shock Trauma Center at the University of Maryland Medical Center, have established integrative medicine units that bring together conventional and alternative approaches to care.

The alternative treatment includes stress reducers like meditation, yoga and massage besides acupuncture and cupping.

Studies show that the number of Americans willing to try alternative treatments continues to increase. A 2007 survey by the federal government found that more than one-third of adults and nearly 12 percent of children in the US used alternative therapies, including acupuncture, chiropractic, homeopathy and herbal supplements.

But many mainstream physicians continue to be skeptical of alternative therapies, alleging their efficacy has not been proven and their successes may be nothing more than variations of the placebo effect.

Concerns over the effectiveness and safety of herbal supplement have prompted the US FDA to issue its first guidelines for good manufacturing practices to improve supplement safety.

The US Federal Trade Commission is also filing more complaints about deceptive marketing in herbal supplements.

source: Xinhuanet

Five Chinese drug firms have so far received seed viruses of A/H1N1 influenza from the World Health Organization. These companies are striving to have the first batch of the vaccine ready to go by August.

Researchers at this biotechnology company in Beijing are busy duplicating the seed viruses of the A/H1N1 flu.

It’s a critical step before the vaccine can go into production.

Zou Yong, manager of Quality Supervision Department of Sinovac Bitotec, said, “In order to meet the demand of large-scale vaccine production, we need to duplicate the seed one thousand times. The production period is expected to last 40 to 50 days. So we estimate the first batch of vaccines will be produced as early as the end of July.”

According to the State Food and Drug Administration, or SFDA, there are a total of 11 flu vaccine manufacturers in China.

Between them, they can produce 360 million doses a year. And of those 11, five have already received seed viruses from the WHO. The rest are scheduled to receive them by Saturday.

Meanwhile, China is waiting for the WHO to decide on whether the A/H1N1 flu should be categorized as seasonal or pandemic.

The SFDA says the scale and pace of the production will be decided by the spread and development of the virus.

Source: CCTV

What to drink green tea benefits? First of all, necessary to understand the composition of green tea, confirmed by modern scientific research, green tea contains more than 450 kinds of organic compounds, more than 15 kinds of inorganic minerals, most of these components are health care, disease prevention, such as effectiveness. Therefore, green tea is known as the protector of rare.

(A) of the efficacy of green tea have a radiation protection
Who regularly drink green tea to use computers to supplement the specific plant nutrients, the elimination of computer black eye caused by radiation. By the concentration of green tea contain polyphenols, can inhibit the free radicals on the skin to support the fiber damage is recognized the most effective anti-free radical factor. Low-caffeine drink green tea not only removes the black eye, which contains catechins, which help the body fat metabolism, but also help to sleep, sleep quality can not only stability, but also make people less likely to have the feeling of fatigue.

(B) beauty detoxification effect of tea
Whether foreign, tea has proved to be a healthy drink, compared to coffee, but also by the size of welcome young and old, although a cup of tea every day, but not everyone is a tea expert, it is necessary to have a healthy drink tea, in fact, will also contribute greatly to knowledge , especially in Western-style tea, you may be most frequently in touch with more than tea bags. However, leisure time, may wish to stress that serious red tea pot, tea detoxification beauty at the same time more effective, than any building even more drinks.

(C) can beautify a person with more green tea
Green tea can even more beautify a person, no doubt! Because it is not only rich in vitamin C, flavonoids, of which vitamin C can enhance the efficacy of the antioxidant, which is also a valuable nutritional flavonoids … the main ingredients of propolis, so it is the maintenance of skin whitening, the young can be said to have rare-class results.

(D) the efficacy of green tea has weight loss
The caffeine in tea, inositol, folic acid, pantothenic acid and aromatic compounds and other substances to regulate fat metabolism, especially the tea on the protein and fat have a very good role in the decomposition. Tea polyphenols and vitamin C can reduce cholesterol and blood fat, so drink to lose weight.

(E) green tea to cancer prevention
The ingredients contained in green tea polyphenols and caffeine, both arising from the combined effects, in addition to play a pick-me-up, the effect of repose, but also have the ability to enhance the body’s immune and anti-cancer effect. In recent years, the Federation of American Chemical Society found that tea not only to the digestive system have inhibited the effectiveness of cancer, but also skin and lung, liver cancer is also inhibited. After scientific research confirms that the organic tea anti-cancer substances are mainly tea polyphenols, theophylline, vitamin C and vitamin E; tea anti-cancer elements in the main inorganic selenium, molybdenum, manganese, germanium, etc.. Chinese, Japanese scientists believe that the catechin polyphenols in the best anti-cancer effect

Tui na is a form of Chinese manipulative therapy often used in conjunction with acupuncture, moxibustion, fire cupping, Chinese herbalism, tai chi and qigong.

Tui na is a hands-on-body treatment using acupressure that is a modality of Chinese medicine whose purpose is to bring the body into balance. The principles being balanced are the eight principles of Traditional Chinese Medicine.The practitioner may brush, knead, roll/press and rub the areas between each of the joints to open the body’s defensive chi and get the energy moving in both the meridians and the muscles. The practitioner can then use range of motion, traction, massage, with the stimulation of acupressure points and to treat both acute and chronic musculoskeletal conditions, as well as many non-musculoskeletal conditions. Tui na is an integral part of Traditional Chinese Medicine (TCM) and is taught in TCM schools as part of formal training in Oriental medicine. Many East Asian martial arts schools also teach tui na to their advanced students for the treatment and management of injury and pain due to training. As with many other traditional Chinese medical practices, there are several different schools with greater or lesser differences in their approach to the discipline. It is related also to Chinese massage or anma.

Tui na has fewer side effects than modern drug-based and chemical-based treatments. It has been used to treat or complement the treatment of many conditions; musculo-skeletal disorders and chronic stress-related disorders of the digestive, respiratory, and reproductive systems.

The words Tui Na translate into ‘push-grasp’ or ‘poke-pinch’ in Chinese. Physically, it is a series of pressing, tapping, and kneading with palms, fingertips, knuckles or implements that help the body to remove blockages along the meridians of the body and stimulates the flow of qi and blood to promote healing, similar to principles of acupuncture, moxibustion, and acupressure. Tui na’s massage-like techniques range from light stroking to deep-tissue work which would be considered too vigorous or too painful for a recreational or relaxing massage. Clinical practitioners often use liniment, plasters, herbal compresses and packs to aid in the healing process, which should be used with caution on sensitive skin. Tui na is not used for conditions involving compound fractures, external wounds, open sores or lesions, phlebitis, or with infectious conditions such as hepatitis. Tui na should not be performed on the abdominal portion of a woman in menstrual or pregnant periods, and it is not used for treatment of malignant tumors or tuberculosis.

In a typical adult tui na session, the patient wears loose clothing and lies on a massage table or floor pad. After answering some brief questions about the nature and location of the health problem as well as basic questions about general health, allergies and other existing conditions, the practitioner will concentrate on specific acupressure points, energy trigger points, muscles and joints surrounding the affected area. Occasionally, clothing is removed or repositioned to expose a particular spot that requires direct skin contact. The patient should always be informed before this act, and no inappropriate or unexpected contact should ever be made in a professional session. Treatment sessions last from 10 minutes to over an hour. Patients often return for additional treatments for chronic conditions.