Introduction
In this article, we are going to be looking into the effects acupuncture has upon the lymphatic system, nd will be looking into whether it is beneficial in assisting the this system.
The lymphatic system forms part of the bodies immune system, it is made up of lymph vessels, lymph nodes, adenoids and tonsils, the thymus and spleen (*1).
The lymphatic system’s job is to filter out waste and toxins from the blood stream, push back the clean blood into the veins so the waste is expelled from the body through the urinary tract. The lymphatic system doesn’t have an involuntary ‘pump’ system like the circulatory system, the lymph can only be transported through the lymphatic system with the help of manual movements such as, muscle contraction, ‘Intrinsic physiological factors such as skeletal muscle contraction, intestinal mobility, and respiratory motions facilitate the flow of lymph through the lymphatic vessels’(*2) or diaphragmatic breathing, ‘Diaphragmatic breathing creates a vacuum effect that increases the rate of toxic elimination through the lymph as much as 15 x the normal rate.’ (*3)
It can also take place using manual lymphatic drainage massage. This happens through pressure to push the lymph through the nodes and back to the subclavian veins.
The right side subclavian vein filters around 25% of the body’s lymph whereas the left subclavian vein filters the remaining 75%. It is estimated roughly 90mmHg of pressure is require to pump the lymph fluid from the foot and return it to the central veins.(*4) There are different types of lymphatic drainage massage the most commonly known and used is the Vodder method, The Vodder method can be dated back to the 1930’s where the physiotherapist developed the method to stimulate the lymphatic flow. The technique was initially developed to treat chronic sinusitis and respiratory problems, it was quickly discovered that the method would help treat and benefit a wider range of health conditions such as Lymphoedema and other swelling and water retention conditions. There has since been more research completed around the subject and newer technique developments to maximise the efficiency of the lymphatic system. In other countries such as Brazil they have discovered how important the lymphatic system can be for everyone’s overall health and wellbeing and Lymphatic Drainage Massage is a regular treatment they receive to support a healthy lifestyle. This technique is now more widely being introduced in other countries in and around Europe.
Acupuncture has been used for thousands of years and is one of the oldest methods of Traditional Chinese Medicine or TCM. It was discovered that pain can be alleviated in one part of the body by pressure in another part of the body.(*5)
Acupuncture uses the use of meridians throughout the body. A meridian is an energetic channel that runs through the body relating to a specific organ, the meridian connects the surface of the skin to the organs. There are 12 regular meridians, 6 Yin and 6 Yang. These channels are also paired, and connect together to create balance. When a meridian or organ is out of balance, possibly in excess or deficiency, is when clients can start to see issues and symptoms. In TCM acupuncture the Spleen Meridian aids the transportation of fluids and food into Blood and Qi (energy). The spleen as an organ, also forms part of the lymphatic system and is actually the single largest component of the lymphatic system(*6). This would suggest that any acupuncture point used upon the spleen meridian could have a direct effect on the lymphatic system. In TCM oedema can be as a result of spleen yang deficiency. This is due to the spleen lacking in function and not allowing the transformation and transportation of fluids. Although within TCM each organ has a role and relationship, therefore other meridians and subsequently acupuncture points can also have an effect upon the lymphatic system, such as the Kidney meridian. In western medicine we know the kidneys cleanse and filter about half a cup of blood every minute; removing waste, toxins and extra water to create urine(*7) Therefore toxins and waste that are filtered by the lymphatic system are also filtered by the kidneys and excreted through the urinary system. In TCM one of the functions of the Kidney meridian is to govern the water and water metabolism, it controls the flow of body fluids in the lower burner (San Jiao / Triple Warmer). Kidney yin and Kidney yang need to be at balance to aid the regulation of urination. The kidneys also make hormones that help control blood pressure and make red blood cells(*8) The lymphatic system likewise aids in the transportation of hormones throughout the body.
In regards to TCM acupuncture the lungs also play an important role in the regulation of the water passages. The lungs receive fluid from the spleen and disperse it to the exterior under the skin. If this can’t be done evenly or correctly, fluid build-up can occur resulting in oedema. The lungs also play a role in directing fluids to the kidneys and bladder. Once the kidneys receive the fluids they filter and vaporise the fluid, it is then pushed back up to the lungs. In TCM another function of the Lung meridian is to control the blood vessels alongside the heart, this will directly impact the lymphatic system. As stated earlier the lymphatic system works alongside the circulatory system, filtering out the waste and pathogens from the blood. Another Lung meridian function is to disperse Wei qi otherwise known as defensive qi. This could also be seen to be included in the TCM equivalent of the lymphatic system as this is part of the body’s defensive system. The Wei qi is spread alongside fluid all around the body between the muscles and the skin to protect the body from external pathogens.
Oedema is generalised as swelling of the limbs, this swelling is usually caused by fluid build up in the tissues. Oedema can be caused by a variety of influencing factors such as bad nutrition, sitting or standing for long periods, being overweight or also medications. It can also be caused by deeper internal components such as liver, kidney or heart conditions(*9)
Acupuncture can be used very effectively at treating the root cause of oedema by creating balance in the organs and meridians. In TCM, oedema is a symptom, and by treating the cause of the imbalance internally, symptoms will diminish. In TCM acupuncture, Kidney deficiency is the most commonly treated issue in clinic. Kidney 7, otherwise called Fuliu, for example, is a great acupuncture point for treating oedema, it benefits the kidneys, regulates the water passages and drains damp or damp-heat.
Lymphoedema is another cause of swelling or water retention. Lymphoedema can be distinguished from generalised water retention or swelling as it usually only affects specific parts of the body, and can be classed as a medical condition. There are two main types; genetical and secondary. Genetic, or primary Lymphedema is due to faulty gene expression, affecting the development of the lymphatic system, symptoms will usually develop in childhood or early adulthood. Secondary is a result of a damaged lymphatic System through lack of movement, infections or inflammation that occurs when the system doesn’t work correctly(*10) Lymphoedema caused by genetic expression can not be cured easily, however if known through early detection treatments such as acupuncture could aid management of the condition. By ensuring the body and meridians such as the Liver, Kidneys, Bladder and Spleen meridians, remain at balance, would aid the lymphatic system and prevent it becoming overworked, and subsequently managing the side effects and swelling of Lymphoedema.
As we can see the lymphatic system plays a vital role in a persons health and immunity; when able to work correctly it can filter out harmful infectious pathogens and potentially cancerous cells before they have time to manifest and cause disease in the body. Not only that but enable the body to function correctly and leaving limbs and the body ‘light’ and not overworked but stagnant excess fluid. And as we can see acupuncture can also aid the body in realigning and coming back to balance to ensure each organ can work effectively as it should to carry out their functions. By doing so, this enables the functioning of the whole body, as each organ interacts and aids each other. I believe acupuncture can directly impact the lymphatic system due to each organ’s function and role in the body. Using acupuncture can bring the body back to balance and allowing organs to correctly function, therefore the lymphatic system can also work effectively at removing the pathogens from the body and filtering out the fluid that runs throughout.
Experimental Method
Participants all suffer with oedema, swelling or Lymphoedema, the participants have completed a acupuncture diagnosis form. The participants will come into clinic for a weekly acupuncture sessions that will last around 30mins, this is the time needed for the Qi to do a full circuit of the body and meridians. All participants will likely use Spleen 6, Spleen 9 and Kidney 7, these are widely used points for oedema and swelling of the legs. Each participant may have additional acupuncture points based upon their own individual needs. They will have four weekly sessions. The aim of the research is to see if their symptoms reduce throughout the weeks.
All participants will be encouraged to improve their diet by eating as clean, fresh as possible avoiding foods high in sugar, sodium and complex carbs. This will aid the benefits of the acupuncture sessions as to not slow down the lymphatic system further. Each participant will be advised to consume water based upon their individual goal 0.035 x (body weight kg) = personal litres of water to be consumed per day.
I hypothesise that acupuncture will reduce the swelling of the participants therefore having a benefit upon the lymphatic system’s ability to filter waste from the body.
Results
Client A
Client A has a family history of Lymphoedema and has started to notice symptoms starting in themselves. Such as swelling of the lower legs and ankles, tightness and occasional pain. They are an office worker and movement is low during the day. The tongue showed quite pale with signs of scalloped edges, also a line in the heart area possibly due to grief.
Needle points used were Spleen 6, spleen 9, spleen 10, kidney 7, large intestine 11 and Du20.
Following session 1, they noticed a difference in the feeling of their lower limbs. Swelling didn’t necessarily decrease however the tightness and pain had reduced. They also reported better sleep.
The same needle points were used for all four sessions on client A. At the end of the four sessions client A, reported a huge decrease in heaviness and tightness of the skin compared to pre-acupuncture. After the sessions client A also had a decrease in blood pressure to within a normal range. After being prescribed BP medication the nurse told client A the tablets wouldn’t have taken affect yet and the reduction was no doubt a result of the acupuncture sessions. Client A has also taken on lifestyle changes such as focusing on diet, drinking her recommended water intake per day, and increasing movement during the day to get the lymphatic system working. The client’s tongue had drastically improved even from one session but from first to last, the colour of the tongue was pinker and less pale. The signs of qi deficiency in the scalloped edges have almost all gone.
After the 4 sessions client A also had a treatment of manual lymphatic drainage massage. Client A felt lighter all over following the treatment.
Client B
Client B presented with severe swelling of the lower limbs. Minimal indications on the diagnosis form. Tongue had heavy yellow coating suggesting heat and damp in the system.
Needle points used: Spleen 6, Spleen 9, spleen 10, kidney 7, Large intestine 11.
Following session 1 client B reported weeping of clear fluid from the needle points. They felt quite tired following the session but did sleep well. On session two I clustered spleen 9 needles to aid maximum transportation of fluids, advised the client to move a lot more throughout the day also.
The weeping of fluids can be seen as a good side effect of the treatment as the excess fluid is managing to be drained where the lymphatic system can not cope with the amount of drainage needed.
Again after the 4 sessions were completed client B reported feeling a lot better and had less heaviness in the legs however the swelling was still present. The tongue on the final session was much less red showing signs of heat were reduced. The yellow damp heat coating had almost all gone too, only showing slight remaining damp heat in the spleen/stomach area, however this has hugely reduced from the first session.
A lymphatic drainage massage was also done after the four acupuncture sessions. Client B felt immediately lighter and was extremely happy with the results.
Client C
Client C also has a family history of lower limb swelling, heaviness and occasional pain.
Needle points used were Spleen 6, Spleen 9, spleen 10, kidney 7, Large intestine 11.
Tongue: showed heat in the spleen, stomach area and down each side of the heart line.
Following session 1, client C reported feeling great and had a great night sleep. They did have slight swelling still, but not as extreme as usual and no heaviness or pain. Client C would usually notice swelling and heat of the legs especially when drinking alcohol, they drank alcohol on two separate occasions between the sessions and didn’t experience any swelling or heat whilst doing the acupuncture sessions. The tongue on the final session showed heat from the spleen and stomach area has also drastically reduced compared to the first session. The redness or heat that was around the heart line has also gone completely.
Again Client C also had a Lymphatic Drainage Massage after the four sessions and was left feeling lighter.
Conclusion
Whilst the three clients from the study didn’t notice many physical changes in their swelling, they all reported feelings of lightness, less heaviness in the legs and reduced heat, they all also reported feeling better within themselves. Client A and B couldn’t put into words how the changed had affected them but both were certain they felt a benefit and felt better following the four acupuncture sessions. I do believe the acupuncture had a positive result on their lymphatic system, I also believe this would of enhanced the results of the lymphatic drainage massage. More research does need to be completed upon this area.
I believe each of the clients would benefit from more sessions of acupuncture until their body and organs are fully balanced and able to function correctly. There are ways in which to improve the research on this area; if completing more research I would add the following changes.
A wider group of participants would be optimum, this would allow for more concise evidence. I would also have more groups to compare the results for example, an acupuncture only group, a lymphatic drainage only and a combined group, who receive both treatments. This would give more effective and comparable results for an overall impact that acupuncture has upon on the lymphatic system. I would also suggest including lung acupuncture points, these would aid higher flow of the fluids and spread of the defensive Wei qi through out the body. Therefore supporting the spleen, kidneys and the lymphatic system.
It is also my opinion that more research is need upon the hormonal imbalances of the body and the direct impact they have upon the lymphatic system’s ability to function. Acupuncture again can be used to address hormonal imbalances, and therefore the lymphatic system can correctly transport hormones throughout the body. There is potential that hormonal imbalances affect the results of this study, as each participant reported they were either menopausal or pre-menopausal by their own assumptions not that of a medical professional.
Author:
Amy Harrison, BSHons MAA RBAF.
Sport & Wellbeing Massage Room , Warrington.
References
(1) Lymphatic System: Function, Conditions & Disorders (clevelandclinic.org)
(2) Lisa M.Hodge, Phd- International journal of osteopathic medicine.
(3) JW Shields- Lymph, lymph glands and homeostatsis lymphology 25(4);147-53 Dec.1992
(4) Aukland, K Reed RK, 1993
(5) Ifrim Chen F, Antochi AD, Barbilian AG. Acupuncture and the retrospect of its modern research. Rom J Morphol Embryol. 2019;60(2):411-418. PMID: 31658313.
(6) Seitai (Lymphatic) Shiatsu, Cupping and Gua Sha for a Healthy Immune System
By Dr. Richard Gold
(7)www.niddk.nih.gov/health-information/kidney-disease/kidneys-how-they-work
(8) www.niddk.nih.gov/health-information/kidney-disease/kidneys-how-they-work
(9) Swollen ankles, feet and legs (oedema) – NHS (www.nhs.uk)
(10)www.nhs.uk/lymphoedema