What is a Scar?

A scar is fibrous connective tissue that patches up an area of skin or muscle that has been injured in some way either from a burn, cut, infection, or other damage. Scar tissue is the body’s way of healing after a trauma but it does not function quite as well as skin or muscle. However, scars do not have to be permanent. Connective tissue can be softened, broken down, changed, integrated, and healed.

Types of Scars

A keloid scar. This would be considered a yang scar in Chinese medicine.

From a Chinese medicine perspective scars can be yin or yang. Yin and yang are always relative, but in general a yin scar will be pale, sunken, and soft. A yang scar will be darker, raised, and more rigid. Some scars are a combination.

In Western physiology scars are categorized as keloid, hypertrophic, and contracture, and also acne scars. Keloid scars are raised above the skin and usually darker or redder than the skin tone. Hypertrophic scars are similar to keloids but not raised above the surface of the skin. Contracture scars can occur with burns and cause the skin and fascia to tighten which can affect muscles, nerves, and even organs. Acne scars are also common and appear as small pits in the skin.

Why Treat Scars?

Scars come in all shapes and sizes from small and barely noticeable to life-altering scar tissue that covers the body. If a scar is causing discomfort, pain, or dysfunction it is important to get scar therapies.

Any scar is on some level restricting the free flow of movement and function in the body (aka qi). Most of the time this will not impact quality of life, but larger, deeper, older scars can be a source of localized or radiating pain, restricted movement, and depending on the location and depth, interference with proper organ function.

Although often scars will fade with time, they also have a tendency to harden over time and continue to restrict the surrounding fascia without treatment.

The Goal of Scar Therapy

The goal of scar therapy is to return the scar to as much normalcy as possible in terms of appearance, movement, sensation, and function. It depends on the size, depth, and age of the scar, and the general health of the skin and the body. But therapeutic interventions can resolve pain and numbness in the area, help bring back movement in a joint, reduce the appearance of the scar, and make the scar itself more integrated and functional with the surrounding tissues.

Methods

Acupuncture

A yin scar from multiple surgeries on the lateral left leg. Acupuncture needles are surrounding the scar bringing about increased blood circulation and gently breaking up the scar tissue.

One acupuncture technique for scars is “surrounding the dragon” where needles are inserted all around the perimeter of the scar with the goal of bringing qi and blood circulation to the areas. This also serves to loosen the surrounding fascia and relieve radiating pain and tension.

A more assertive technique to to actually insert acupuncture needles underneath the scar to further break down the scar tissue.

Massage

Massage will help soften scars and also free the restricted fascia surrounding the scar tissue. with consistent treatments. Touch itself is very important for healing the emotional trauma around scars. Part of the goal of scar therapy is to integrate the scar tissue with the surrounding area, the same goes for integrating the experience that caused the scar into our life to be able to move on..

Cupping

Cupping can be used directly on the scar or around it to loosen the fascial layers and encourage circulation.

Gua sha

Gua sha may be used around or on the scar. My preferred method is to use a Japanese tool called a chokishin made of silver and do a spreading or gliding stroke over the scar to gently encourage circulation without aggressively trying to break up the scar. But it depends on the scar and what is needed.

Topicals

Vitamin E oil, or grapeseed oil which is high in vitamin E, are both helpful for scars. Castor oil softens hardened areas and masses and is useful for scars. Zheng Gu Shui is an herbal liniment formulated to help heal bones and tendons, but it is helpful for scars by increasing blood circulation and reducing pain.

Conclusion

Scars can heal and it is worth it to seek out simple therapies that can treat your scars and improve your quality of health and life.

In the teachings of traditional Chinese medicine the Lung is much more than a physical apparatus. It is a system of functionality within the body that includes breathing, the strength and quality of the voice, functioning of the the nasal passageways, sinuses, throat, lungs, and skin. The Lung regulates and distributes water in the body, and when it is malfunctioning it produces pathological phlegm, or mucus, that can obstruct the nose, throat, voice, lymph pathways, skin, and chest.

Note: in this post, when referring to the entire system of influence from a traditional Chinese medicine perspective the name of the organ will be capitalized: the Lung, the Heart etc. When referring to to the biomedical model of the discrete organ it will be lower-case: the lungs.

Lung and Large Intestine are the organs of the metal element, or better called the metal phase. Metal is about the functions in nature related to purification and boundaries- that is letting in and letting go- and the emotion of grief around the process of letting go. On a basic physical level as we breath in we are connecting to the outside world, we are literally bringing in the air of the world into our bodies and into our blood. When we exhale we are letting go of metabolic waste products that if kept in our bodies would be very harmful.

The Lung also houses a particular aspect of the spirit, called the po, the corporeal spirit. The Lung plays the role of minister within the body, advising and protecting the Heart, the emperor.

Thyroid: the Gland of the Lung

Even though Chinese medicine did not acknowledge the thyroid gland as a discrete gland, it is still considered part of the Lung function.

The fascial planes that separate the different layers, sections, tissues, and organs in the body run along specific pathways to organize the body. There is evidence that the fascial planes correspond closely to the channels in Chinese medicine theory, one of the best physiological explanations for the connection between limbs and organs.

In the case of the thyroid and Lung channel there is a specific fascial plan, the precervical fascia, that connects the thyroid gland to a key point on the Lung channel located on the outer chest. Functionally the thyroid hormone regulates cellar respiration, as well as breathing and heart rate. Embryologically the lungs and the thyroid both grow from the primitive pharynx.

Physiologically the only actual connection the lungs have to the rest of the body is the larynx, the voice box, so the “quality of the voice” as diagnostic for the Lung has a clear physiological reason.

Lung and Blood

In the biomedical model the shape of the lungs are very similar to a tree, where the “trunk of this tree is our windpipe, the branches are the main bronchi, the twigs are the bronchioles and finally the leaves are the alveoli. (Keown)”

The blood is “wafted” from the heart into smaller and smaller waterways until it is a single blood cell that can interchange carbon dioxide and oxygen with the alveoli. The space between the alveoli serves the same function as the space between the leaves on a tree- for sunlight, or in the case of the Lungs, spirit, to circulate.

Lung and Heart

The Heart and Lung are both located in the uppermost part of the thorax, or upper jiao, and both have roles on governing or overseeing the other organs. In Chinese medicine the Heart is called the emperor and the seat of the spirit, the shen which is translated literally as heart-mind. The Lung is the minister and regulates and filters what reaches the emperor. Therefore breathing exercises to strengthen and purify the lungs, used in many systems of spiritual practice such as meditation and yoga, are important to relax and calm the heart-mind, the spirit.

Breath and Spirit

Breath is linked to spirit in almost all cultural traditions. Air is the most rarified element and the closest to the invisible source of life. When we breath we take in this invisible force that grants us life at each moment. Most spiritual exercises such as meditation, qigong, yoga etc. involve an awareness of the breath to attune more to the spiritual aspect. The Lung is called the “delicate organ” in Chinese medicine and is easily damaged by outside pathogens. Yet this same delicacy allows the most subtle and spiritual element to enter into our bodies and transform into our life force.

Pathologies of the Lung

Allergies, asthma, shortness of breath, phlegm or mucus in the nose, sinuses, throat, or chest, nosebleeds, disliking of speaking, sore throat, sinusitis, rhinitis, emphysema, cough, common cold, unresolved grief, low immunity. The Lung “system” encompasses all of these types of pathologies, which are caused by a deficiency of qi, or proper movement and functionality of the lungs, the thyroid, cellular respiration, blood nutrient exchange, and state of the heart-mind. These physical organs and glands are connected by the conductive fascial planes that travel down the anterior chest and arm, and therefore stimulating a point on the arm can treat these pathologies.

Reference
Daniel Keown, The Spark in the Machine: How the Science of Acupuncture Explains the Mysteries of Western Medicine 

Cupping as Medicine

Cupping is a healing modality with ancient roots that is still widely practiced today. Traditionally cupping was used to treat disease by pulling pathogenic factors such as excess cold, heat, wind, or stagnant blood and fluids to the surface of the skin to clear out through the pores.

In Chinese medicine cupping is used to treat disease, including arthritis, chronic pain, colds, flus, and liver disorders. Cupping is also practiced as manual therapy to resolve pain and tension, decompress restricted fascia, and increase circulation.

Mechanism of Action

Cupping uses a negative pressure created by a pump, suction, or vacuum. Cupping draws stagnant blood and fluid to the superficial vessels, thereby increasing circulation and lymph flow within the layers of the fascia.

The Discoloration/ Cupping Marks/ Sha

Cupping draws blood and fluids to the superficial vessels, temporarily filling them and creating a mark that looks like a bruise or rash. This discoloration is temporary and usually fades in a couple of days to a week. Unlike a bruise, the treated area feels immediate pain relief and resolution of tension.

Even if the discoloration does not appear there are still beneficial changes in the texture, temperature, and appearance of the skin and myofascia.

Styles of Cupping

All cups have a way to create a negative pressure. The most common styles of cups we see today are fire cups, external pump cups, silicone cups, and facial cups.

Fire Cupping

How Fire Cupping Works

Fire cupping uses simple cups made of non-flammable material, usually glass but sometimes bamboo or ceramic. A vacuum is created by removing the oxygen in the cup with a controlled flame, such as a lit cotton ball soaked in rubbing alcohol or a small charcoal on a metal handle. The flame is inserted into the cup and quickly removed and the cup placed on the skin. The vacuum created inside the cup causes the muscle tissues to be pulled up inside.

Fire Cupping and Traditional Chinese Medicine

Fire cups are necessary in order to use several techniques of traditional Chinese medicine including bleeding cupping, herbal medicinal cupping, and combined moxibustion or needling with cupping. Fire cups are the most traditional form and that style has a special place in the heart of many practitioners.

Practical Considerations

Tthe glass cups can get very warm and can create a very strong suction, arguably the strongest potential suction of all the types of cups. The glass cups are easy to clean and disinfect, but can break when dropped, or the rim can become chipped..

Fire cupping is somewhat difficult to learn at first and requires some practice, and there is a danger of burning when not done properly, mostly from the possibility of the cup getting too hot.

Glass cups can glide on the back but do not glide very well on other parts other body, and they are difficult to control the suction level. Overall fire cups are best used by acupuncturists using traditional techniques.

Fire Cupping and Massage Therapy

While cupping is in the scope of practice for massage therapists in most states, fire cupping in particular is not covered by many of the professional massage liability insurance carriers. To find out if this applies to you check with your state massage board and professional liability insurance carrier.

External Pump Cups

This style of cups usually come in a set of multiple size cups made of either plastic or polycarbonate, with an external pump. Suction is created by using the pump to draw the muscle tissues inside the attached cup. The most common type is the hand pump or pump gun, but there also exists a machine pump.

How External Pump Cups Work

The cups pop right into the pump and suction is created by squeezing the pump or setting the machine. With the pump it is possible to control the suction easily, and without taking the cup off the body. External pump cups can be used for self-care even on the back and shoulders. They attach easily to areas around joints such as elbows, wrists, the lateral and posterior neck, knees, and ankles.

These cups are somewhat difficult to clean and properly disinfect because of the valve in the cups and the possibility of body fluids entering the pump. The cheaper plastic cups are breakable, the polycarbonate cups are much more sturdy. With their thin rim and domed shape these cups are difficult to do gliding techniques.

The biggest cups in the sets still tend to be smaller than the large fire cups or silicone cups. However in the machine pump sets there are very large cups.

Silicone Cups

Silicone cups are made of medical-grade silicone and are self-suctioning. The common types are the mushroom shaped cups and the dome shaped cups.

The technique of squeezing and applying the cup to the body can be mastered in minutes. These cups contour to the body and glide easily. They can be easily cleaned and disinfected, and do not break down, fray, or lose shape over time.

Amplifying the Suction

Even though silicone cups have limited suction compared to other styles, it is possible to amplify the suction by placing multiple cups in one area, or by pulling up on the cup when gliding. The mushroom shaped cups are easier to glide and provide greater suction than the dome shaped cups.

The quality varies somewhat, which is true of all the styles of cups. Be wary of silicone cups that have a visible center seam, which shows a cheap manufacturing process and compromises the smoothness of the cup.

The mushroom shaped silicone cups are better to use in clinical practice because they get strong suction than the dome shaped cups and are easier to grip for gliding. The silicone cups are easy to clean and disinfect, they never break when dropped, and are not destroyed by oil like equipment made from vinyl.

Facial and Jaw Cupping

Facial cupping requires specialized cups with very limited suction. Facial cups are either very small cylindrical glass cups with a small rubber bulb, or small conical silicon cups. The technique can be a gentle pumping suction to mimic the lymphatic system or gliding along the face. Facial cupping is meant to improve circulation of blood and fluid and is generally for cosmetic purposes.

Jaw cupping uses a slightly larger cup, usually the largest in the glass facial cupping set and is applies to the muscles of the jaw for therapeutic decompression. This technique is more likely to leave discoloration on the face but is very effective for TMD, facial tension, neck pain, and headaches.

The principle of yin-yang is the philosophical basis of all aspects of traditional Chinese Medicine including structural, organic, functional, and mental-emotional. This article will focus on the structural aspect.

 Fundamental Duality

Yin-yang is the fundamental duality of everything in the universe. The Chinese word yin means the “shady side”, yang means the “sunny side”.

Yin is dark, internal, receptive, hidden, in shadow, soft, heavy, cool, wet, in closer proximity to the Earth.

Yang is bright, external, active, exposed, lit-up, hard, light-weight, warm, dry, in closer proximity to Heaven.

Taijitu

Yin-yang theory is foundational in Taoist cosmology and in Chinese medicine theory. The symbol for yin and yang is called taijitu, showing the universal polarity in a constant state of harmonious movement. The taijitu is the combination of two identical intertwined fish-like shapes, black for yin, white for yang, with the seed of each present within the opposite.

Relativity and Polarity

Everything has a relative yin-yang nature. Nothing is ever pure yin or pure yang.

Yin and yang are mutually dependent, they exist always in relation to each other. There can never be yin without yang and vice-versa.

Yang and yin are opposites, but each contains the seed of the other. At high noon, when the day begins its descent toward darkest midnight; yang transforming into yin. In the depths of winter the seasons start to shift toward spring and summer; yin transforming into yang.

Yin-Yang Structure of the Body

Yin-yang in the body is traditionally illustrated by a farmer bending over, working in the field. The back and head are exposed to the sun, yang, while the chest and abdomen and feet are in shadow, yin.

Understanding the relative yin-yang structure of the body is important for diagnosing and treating musculoskeletal issues such as injuries, chronic pain, and degenerative diseases.

The skin is yang (outer) relative to the internal organs (inner). The head is yang relative to the feet, because the head is closer to the Sun (yang) and the feet are closer to the Earth (yin). The tops of the feet are yang while the soles of the feet are yin etc.

The back of the body including the neck, shoulders, back, and the outer parts of the arms and legs are yang.

The front of the body including the face, chest, abdomen, and inner parts of the legs and arms are yin.

The upper back is yang and the lower back is yin. The chest is yang and the abdomen is yin.

The spinal curves have a relative yin-yang relationship, meaning they balance each other. Natural spinal curves provide important shock absorbance, allowing for complex movement.

The cervical and lumbar curves are anterior, they sink in relation to the rest of the back; yin.

The thoracic and sacral/pelvic curves are posterior, they rise in relation to the rest of the back; yang.

The cervical and thoracic yet more yang in relation to the lumbar and sacral/pelvic because they are higher up on the body, more exposed, and closer to Heaven (ultimate yang).

Relevant to Treatment

The more yin structures tend to suffer from weakness but benefit from being relaxed, such as the abdomen. The more yang structures suffer from tension but benefit from being strong such as the posterior shoulder muscles.

However, yin is not the same thing as deficiency or weakness and yang is not the same thing as excess or tension.

It’s also worth noting that because of the modern Western lifestyle emphasis on sitting, most people would benefit from increased strength and relaxation overall, just to maintain basic structural balance.

Conditions to Consider

Low back pain is often from weakness in the corresponding yin aspect: weak abdominal muscles mirroring the low back.

Low back pain also shows up as tension in the more yang aspects of the spine: the lower thoracic and upper sacral. Address abdominal weakness or coldness, and treat the upper sacral and lower thoracic tension to relieve low back pain.

Upper back pain is yang-on-yang tension, within which a hidden yin weakness can be found.

Releasing the tight trapezius, supraspinatus, and infraspinatus is one part of treatment, but then look for overstretched and weak rhomboids, and instability in the cervical curve. Ribs that are stuck or “out” in the back will often have a corresponding tenderness in the anterior ribs.

Create leverage for treatment of stubborn and guarded upper back pain by treating the anterior sterno-costal area.

Shoulder pain can be an excess type where the joint is very stiff, difficult to move, perhaps inflamed. Look for weakness in the low back, abdomen, or legs that might be contributing to overuse of the shoulder, or may undermining its ability to heal properly.

Shoulder pain that is more “nervy” and weak is a deficient type. The affected shoulder will often present as lower, either on the top of the shoulder joint or in the scapula.

The patient may not want the affected shoulder to be touched or treated. The excess type of tension will often be found on the opposite side of the upper back, especially near the vertebrae and paraspinal muscles.

Treating the Whole Person

Yin-yang diagnosis can go even further for pain conditions, especially with incorporating in-depth channel theory, zangfu treatment, and herbal remedies for maximum benefit.

Yin-yang in the body should be functional and natural, creating a harmony of movement for our lives. When it is pathological we use the same principles of balance to address pain and dysfunction.

Note to acupuncturists: Carly Herrero LAc offers an online training course in hospice and home health acupuncture, available worldwide.