Skip to content

PMS

How to Detox With Acupuncture and TCM

Share

By Xiaomei Cai, L.Ac., Ph.D. & Qineng Tan, L.Ac., Ph.D.

herbal detox tea
Chinese herbs detox tea

Why is it important to do a detox or body cleanse periodically? When done with the right support from an acupuncturist near me, detoxing can help improve your digestion, immune function, fertility, and many other aspects of your health. Store bought colon cleanse products or a juice cleanse won’t really do the job, though. A detox program with acupuncture and Chinese herbs will do more to optimize your health than just a detox diet will.

When we recommend our Detox Program at Art of Wellness, we are not talking about fasting or detox drinks, like a master cleanse. The goal of our program is to detoxify the organ systems of the body: it’s a liver detox, kidney cleanse, lungs, heart, and spleen. This is a full body cleanse designed to give you a health reset. According to TCM philosophy, your body knows how to repair and renew itself, but it cannot do this job when it is congested and out of balance.

In TCM, we have a broad concept of what “toxins” are and how they can affect our bodies and our health. Toxic chemicals that come from our environment, such as food additives, pesticides, cleaning products, and beauty and hygiene products are certainly part of the problem. Drugs, medicines, alcohol, and unhealthy foods can also be toxic. So can behavioral habits, like sitting and looking at our screens and devices too long.

But our own bodies produce toxins, too. The waste products our organs create are “toxic,” and if they are held in the body too long without being adequately cleared out, they can negatively impact organ function. Imbalances in the system can cause conditions of excess heat or phlegm, which can lead to all kinds of problems with both your physical and mental health.

Stress, lack of sleep, and extreme emotions can also contribute to toxic conditions in the body and mind. When the organ systems are out of balance, the body is under constant pressure to keep functioning, but we do not feel our best.

Signs you need to detox include:

Inflammation is largely created by toxic conditions in the body, and most pain conditions and chronic illnesses stem, at least in part, from inflammation somewhere.

Why You Need a Liver Detox

tai qi qigong exercise detox
QiGong and Tai Qi exercises help with detox.

In conventional medicine, we think of the liver as being a sort of filter that removes toxins from the blood and helps metabolize fat. In TCM theory, we consider the liver to be the storehouse and distributor of blood; therefore, it also plays a crucial role in the menstrual cycle. The liver is also strongly connected to a person’s emotional life. 

Stress, lack of sleep, too much sugar, alcohol, fatty, fried foods, pharmaceutical medicines, and recreational drugs all tax the liver above and beyond what it needs to do just to keep the blood flowing to nourish the body. When too many demands are placed on the liver, it can cause all kinds of symptoms, including: fatigue, insomnia, and headaches. Feelings of anger, frustration, anxiety, and irritability may arise. Conversely, when a person is feeling bitter and resentful, and isn’t able to express it, those unresolved emotions may begin to cause trouble with liver function.

Just as the liver governs the blood, in TCM, the kidneys govern the water of the body, controlling elimination through the bladder, and maintaining blood pressure by keeping the right amount of water in the bloodstream. Signs that the kidneys are not balanced include: problems with blood pressure, edema, puffiness in the face or extremities, UTIs, chronic fatigue, and menopause symptoms, like dryness and hot flashes.

Detoxing the organ systems, including the liver and kidneys especially, can help rejuvenate the digestion and allow better nutrition to reach all parts of the body, as the quality and flow of blood and other bodily fluids will be improved.

Making sure that your excretory system is in good working order before starting a cleanse is important. If you are already having problems with constipation, for example, we will want to make sure we get things moving before we start cleansing the organs. Our detox also focuses on the body’s largest excretory organ: the skin.

Top 10 Reasons To Detox

detox herbs bath
Relax with detox herbs in your own bath.

It is a good idea for everyone to detox periodically; detoxing every six months is reasonable for most people. Sometimes we will specifically recommend a detox for a patient when they are struggling with a particular health problem, or if they are planning a pregnancy.

Detoxing can help:

  1. Boost Immunity – a cleanse will help get your lymphatic system, which produces and transports immune cells and removes waste from cells, moving, improving the efficacy of your immune system.
  2. Break Free From Addiction – if you are ready, a commitment to the detox program and food plan can help you end patterns of substance abuse, drug use, alcohol addiction, smoking, and other types of dependency.
  3. Infertility – We often advise people who come to Art of Wellness for fertility treatment to begin with the Detox Program. Not only will this help increase the chances of conception occurring, whether naturally or with the aid of ART, but it will also lay the foundation for your child’s health in the future.
  4. Improve sleep – This works both ways. In order for the body to do its routine daily work of removing toxic waste, it needs plenty of sleep. The Liver, in particular, is working hard through the night to clean and deliver fresh blood to the cells. Sleeping on your side enhances your body’s ability to do this work, allowing the internal organs to drain properly. When your body is functioning well, your sleep will be of better quality, more restful and refreshing.
  5. Improve skin and hair – Dull eyes and skin, dark circles or bags, puffiness, and thinning hair are signs of stagnant blood and Qi. Nutrients from the right foods and Chinese herbs help to nourish the skin, and clear heat, dampness, and dryness. When old cells are removed, hair and eyes can shine again. Acupuncture treatment can help stimulate collagen production, which also happens while you sleep.
  6. Weight loss – While our acupuncture detox is not about how to lose belly fat fast, many people will find that it gives them a good foundation for new eating habits. Detoxing the liver and kidneys will help your body metabolize fat better. 
  7. Balance hormones – severe PMS symptoms, bloated stomach and mood swings, perimenopause symptoms, infertility in women and infertility in men (oligospermia) can all be improved when hormone function improves. Acupuncture treatment can also help relieve conditions like PCOS, fibroids/leiomyoma, and endometriosis for women, and BPH in men.
  8. Reduce inflammation – many illnesses and pain conditions are inflammatory in nature. If you are suffering from pain due to plantar fasciitis, gout, rheumatoid arthritis, tennis elbow, carpal tunnel syndrome, shoulder or hip pain, acupuncture can help.
  9. Increased energy – better nutrition, better circulation, better sleep, and better organ function will all work synergistically to help you feel more energetic.
  10. Chronic illness – many chronic illnesses are rooted in toxic conditions within the body or exposure to toxins. Hard-to-treat conditions like autoimmune conditions and other systemic problems may be helped with alternative medicine when conventional medical treatments have not been successful. We treat many conditions with acupuncture and herbs, such as: lupus, lyme disease, celiac disease, fibromyalgia, and Crohn’s disease. We also provide support for people going through cancer treatment.

7 Steps of Detox Program With TCM Acupuncture and Herbs

cupping acupuncture detox
Cupping draws Qi and blood from deep inside the body.

Pain and dysfunction occur when there is imbalance and when there are areas of stagnation within the body. Think of the metaphor of a house that needs to be deep-cleaned; there are dark corners of the body that have been ignored for a while, where dust and cobwebs have gathered. The Detox program reaches into these pockets of stagnation, sweeps them clean, and makes sure they get some fresh air and sunlight shining on them, in the form of invigorated Qi and blood.

  1. Acupuncture Treatments – the primary goal of acupuncture treatments during the detox phase is to get Qi moving freely, remove blockages, and to assist in elimination of toxins from the body.
  2. Cupping Treatment – the TCM modality of cupping creates a vacuum-like suction that moves Qi and blood from the innermost parts of the body outwards. During the detox program, cupping helps to pull toxins out of the lungs and other organs.
  3. Detox Herbs – the Chinese herb detox tea helps to clear heat and toxins from the body and improve digestion and elimination.
  4. Foot Pad Detox – detox foot patches, worn as you sleep at night and removed in the morning, help to pull toxins and fatty deposits from the body. 
  5. Detox Bath – Sweating is an excellent way to remove toxins through the skin; this is why so many traditions rely on saunas and hot baths. Our herbal sachets allow you to enjoy a therapeutic herbal soak in your own bathtub.
  6. Exercise – Your acupuncturist will instruct you on how to practice daily exercises, based on QiGong movements, that will help to get Qi and blood moving.
  7. Nutrition – the food plan during the detox is based on whole grains, lean proteins, and plenty of vegetables, flooding your system with nutrients.

Detox Near Me Los Angeles, Westside

The beginning of the year, springtime, after recovery from a long illness, while preparing for a healthy pregnancy–anytime may be the right time for you to detoxify your system and get a fresh start. We recommend that you take the time to dedicate yourself to a week of cleansing with the Art of Wellness Detox Program at least twice a year for optimal health benefits.

 

 

*This article is for education from the perspective of Traditional Chinese Medicine only. The education provided by this article is not approved by FDA to diagnose, prevent, treat and cure human diseases. It should not stop you from consulting with your physician for your medical conditions. Traditional Chinese Medicine is based on Qi, which is an invisible force that usually cannot be observed by modern science. Because science focuses on testing ideas about the natural world with evidence obtained through observation, these aspects of acupuncture can’t be studied by science. Therefore acupuncture and Chinese herbs are often not supported by double-blind, randomized trials, and they are considered alternative medicine therapies in the United States.

 

 

Share

How to Improve Mental Health With Acupuncture and TCM

Share

By Xiaomei Cai, L.Ac., Ph.D. & Qineng Tan, L.Ac., Ph.D.

mental health acupuncture
TCM can help depression and anxiety.

Mental health problems are becoming more and more prevalent, yet more than half of Americans experiencing mental illness do not get treatment. Mental disorders like depression, anxiety, panic attacks, PTSD, SAD (seasonal affective disorder), OCD, and postpartum depression can be improved with acupuncture and TCM, without negative side effects.

According to the most recent statistics, 19% of all adults in America are currently living with mental illness, while 15% of teenagers report having experienced major depression. Anxiety is the most common mental health condition, with 18% of the population reporting some form of anxiety disorder every year.

Addiction and substance abuse are also on the rise among both adults and teens. About 20% of people who have a mental disorder also have a problem with drug or alcohol addiction. Many people use drugs and alcohol to mask symptoms of depression and anxiety, but this only compounds the problem.

Mental health is about our emotions, our thoughts, and our relationships and social interactions with others. Mental health issues affect our behaviors, our thought patterns, and our responses to stress. TCM is an excellent form of care for mental health, because we take the whole person and their symptoms–mental, emotional, and physical–into consideration every time we work with them. 

It is generally understood that mental health problems can come about due to a combination of factors, including imbalances in brain chemistry, trauma or abuse, and genetics or family history of psychological disorders.

Typical treatment for depression, anxiety, and other mental health problems involves talk therapy and/or prescription medications like antidepressants. Many people are not getting the relief they need from these forms of therapy, and medications can cause unwanted side effects, including headaches, nausea, weight gain, and trouble sleeping. 

TCM takes a holistic approach to mental health and can help relieve signs of depression and anxiousness. TCM herbs and acupuncture can also provide an alternative treatment for many chronic illnesses that can contribute to depression.

Who Is At Risk for Depression, Anxiety, and Other Mental Disorders?

anxiety and depression acupuncture
Anxiety and depression can happen to anyone.

Everyone feels deep sadness and worry at times. When these feelings persist for a long time, they need to be addressed. Anyone, at any age, can experience symptoms of anxiety or depression. But some people are more at risk for mental health problems.

Risk Factors for mental illness include:

  • Family history – if other people in your family have experienced mental illness, you may be more likely to have mental health issues, too.
  • Stress – people who are going through financial insecurity, severe job stress, the loss of a loved one, or the breakup of a relationship are more likely to feel depressed.
  • Trauma – having gone through a traumatic experience, such as abuse in a relationship, or being in an accident, or witnessing something terrible, can lead to feelings of depression, anxiety, or PTSD.
  • Minority and marginalized communities – people who have experienced discrimination due to their race/ethnicity, gender, or sexual orientation are at a higher risk for mental health problems and often face extra barriers when they try to get help.
  • Head trauma – having an injury to the head or brain can cause mental disorders.
  • Chronic illness – having a longstanding serious illness or pain condition that dramatically impacts a person’s quality of life can lead to depression.

Medical science has been able to discern that certain imbalances in brain chemistry, including malfunctioning neurotransmitters in the brain and nervous system, are part of the physical root cause of depression, anxiety, and other mental disorders. Low serotonin, especially, is associated with a depressed mood, insomnia, panic attacks, obsessive-compulsive disorder (OCD), and even suicidal ideation. This is why the medical solution for depression and anxiety is often prescription medications like SSRIs, which impact the levels of serotonin in the brain.

Acupuncture and other TCM treatments can also have a positive effect on neurochemistry, without the dependence or side effects that medications can cause.

Can Acupuncture Help Mental Health Problems?

TCM has become more and more accepted by the scientific community as an effective way to relieve depression, anxiety, PTSD, and other mental disorders.

The Five Elements Theory used in TCM allows us to link physical, emotional, and mental symptoms of depression and anxiety and see specific patterns.

A medical doctor or therapist may hear that a patient has headaches, gastric upset, sleep problems, and episodes of anger, and view these as separate symptoms, treatable by separate medications. The acupuncturist sees a pattern that points to a particular imbalance in the organ systems. 

TCM can help many mental health issues, including:

  1. Depression – according to TCM, depressed mood is usually related to some form of stagnation in the Qi of the liver, kidney, spleen, and/or heart. Feelings of grief are associated with the lungs.
  2. Anxiety – Depression with anxiety is often due to a deficiency of Yin, which can cause sleep problems, back pain, and irritability. Excessive worrying is related to the spleen. Studies have indicated that acupuncture treatment facilitates the release of serotonin, endorphins, and norepinephrine, which can help to calm feelings of anxiety, even immediately after treatment.
  3. Panic Attacks – TCM can help people with panic disorders. The intense feelings of fear that can come on with a panic attack may be related to the kidneys, which are involved in the release of adrenaline and cortisol, the “fight or flight” hormones. 
  4. PTSD – Sometimes people suffering from PTSD or other trauma-related mental health problems are unable to go through talk therapy in order to deal with their feelings. There can be all kinds of reasons why a person is not able to speak about abuse or horrors they have suffered. Acupuncture treatments offer a real solution to ease the heavy feelings. A TCM provider offers healing by being able to sense a person’s energy, and facilitate shifts in that energy.
  5. SAD – Some forms of depression are temporary, but that doesn’t mean that they aren’t serious or don’t require attention. Seasonal affective disorder (SAD) affects many people, year after year. Acupuncture can help prevent this cycle from recurring.
  6. PMS/PMDD – People who menstruate often experience PMS (premenstrual syndrome), which can have emotional and mental symptoms. PMDD, an extreme form of PMS, can cause severe feelings of depression and even suicidal ideation. Acupuncture and herbs are an excellent way to address all kinds of problems with the menstrual cycle, including intense mood swings.
  7. Postpartum Depression – Many women experience depression during pregnancy and postpartum depression after having given birth. This condition, brought on by dramatic changes in hormones, can affect a new parent’s ability to care for themselves and their baby. Acupuncture treatment can effectively address postpartum depression, without fear of side effects from drugs.
  8. ADD/ADHD – ADD/ADHD are mental health disorders that affect a person’s ability to concentrate and can cause hyperactivity, mood swings, and social problems. Acupuncture and TCM can help both adults and children who are having problems with attentiveness, frustration, and restlessness.
acupuncture treatment
TCM can help all types of mental health issues.

Acupuncture can also help people who are struggling with substance abuse and addiction. Addictive behaviors are related to brain chemistry, and acupuncture can be utilized as an effective treatment for symptoms of withdrawal and as support for the mental and emotional aspects of recovery from alcohol or drug addiction.

Many people who are living with serious chronic illnesses also suffer from depression. When a health condition impacts a person’s quality of life every day, it can feel defeating and exhausting. 

Neurological disorders that affect the brain, such as Alzheimer’s, dementia, and Parkinson’s disease, can create feelings of anger and frustration, bringing about changes in personality. 

Autoimmune disorders like Crohn’s disease, Rheumatoid arthritis, ME/CFS (chronic fatigue syndrome), Lyme disease, MS (multiple sclerosis), and Lupus–can also engender feelings of depression because it can be so difficult to find treatment for their symptoms. People with serious conditions like HIV/AIDS and ALS are also apt to suffer from depression. Acupuncture and TCM not only provide help for the depression, but may be able to provide an adjunct or alternative treatment for these conditions, providing long-sought relief from symptoms and frustration.

Acupuncture Near Me For Mental Health Care in Los Angeles

If you or someone you know is suffering from mental illness, consider acupuncture as an alternative or adjunct to therapy and medications. People with mental health issues need a support system. At Art of Wellness in West LA, we have over 30 years of experience helping people find relief from the emotional, mental, and physical symptoms of anxiety and depression.

 

*This article is for education from the perspective of Traditional Chinese Medicine only. The education provided by this article is not approved by FDA to diagnose, prevent, treat and cure human diseases. It should not stop you from consulting with your physician for your medical conditions. Traditional Chinese Medicine is based on Qi, which is an invisible force that usually cannot be observed by modern science. Because science focuses on testing ideas about the natural world with evidence obtained through observation, these aspects of acupuncture can’t be studied by science. Therefore acupuncture and Chinese herbs are often not supported by double-blind, randomized trials, and they are considered alternative medicine therapies in the United States.

Share

How to Treat Meniere’s Disease With Acupuncture and TCM

Share

By Qineng Tan, L.Ac., Ph.D. & Xiaomei Cai, L.Ac., Ph.D.

dizziness vertigo spiral stairs
Vertigo, dizziness, sensation of spinning, are possible signs of Meniere’s disease.

My ear feels clogged sometimes, I get sudden dizzy spells, and sometimes I think I’m losing hearing in one ear! These symptoms could be signs of Meniere’s disease, a condition of the inner ear that causes ringing in the ears or buzzing sounds, sudden hearing loss, and vertigo–that spinning sensation sometimes accompanied by nausea. Acupuncture is an effective vertigo treatment and can help resolve the dizziness and hearing problems associated with Meniere’s.

A lot of people may not realize that they have Meniere’s disease, because the most common symptoms can also be indicators of many other health issues. For example, sudden attacks of vertigo can be caused by a condition called benign paroxysmal postural vertigo, or BPPV. BPPV is another kind of inner ear problem, caused by the movement of small crystals of calcium carbonate into a part of the ear canal where they do not belong. Vestibular migraine and other types of migraine headaches can cause feelings of vertigo and ringing in the ears. Ringing in the ears, also known as tinnitus, can also be a symptom of a sinus or ear infection, thyroid problems, cardiovascular problems, or caused by repeated exposure to excessive noise levels.

Meniere’s disease is a chronic condition that can begin at any time during life, but it is most commonly diagnosed when a person is in their 40s or 50s. Most of the time, Meniere’s symptoms only affect one ear. A “Meniere’s attack” can come on in a way that is similar to a migraine. First there may be subtle signs that it is starting, like changes in hearing, or a feeling of fullness or congestion in one ear. Then, a sudden and strong attack of vertigo can make you feel so dizzy, light-headed, and off balance that you have to lie down. You may even feel nauseated to the point of vomiting. These episodes of intense dizziness can last anywhere from several minutes to several hours, or even a whole day. Afterwards, you may feel exhausted and need to rest. Never knowing when you might have one of these attacks of severe vertigo can be very disruptive and unsettling, really having a negative impact on your life.

Each person’s experience of Meniere’s disease is different, and there is no clear cause for the disorder. Over time, some people may have fewer and fewer symptomatic episodes, while other people may have them more frequently and may begin to develop more serious hearing problems. Hearing loss associated with Meniere’s disease may seem to come and go at first, but it can progress to the point of permanent hearing loss, or deafness.

What causes Meniere’s disease? Medical science is unclear as to why some people develop this inner ear problem, but it is generally believed to be related to excess fluid in the ear. Meniere’s symptoms might develop after some type of head injury or ear infection, respiratory infection, or viral infection. Meniere’s may be related in some cases to migraine headaches, or to immune system dysfunction. Some women experience Meniere’s symptoms during their premenstrual syndrome (PMS) week. As with many other illnesses, Meniere’s can be triggered by stress or anxiety. Currently, Meniere’s treatment typically involves medications that offer some symptomatic relief, like anti-nausea medications.

Acupuncture and other TCM treatments for Meniere’s disease offer a holistic way to address the varying symptoms of dizziness, vertigo, nausea, tinnitus, and hearing loss. While there is no cure for Meniere’s, it is possible to reduce the symptoms so that they are not so bothersome anymore and even to help prevent further hear loss.

Top 5 Symptoms of Meniere’s Disease

Meniere's dizziness vertigo hearing loss
Meniere’s usually hearing problems in one ear.

Meniere’s symptoms can be subtle at first, and a person may only have a few episodes of ringing in ear or vertigo once in a while. The common signs of Meniere’s include:

  1. Dizziness, vertigo, spinning sensation, light-headed 
  2. Hearing loss, hearing problems, sudden drop in hearing, sounds are muffled
  3. Tinnitus, ringing in the ears, buzzing sound, roaring in ear
  4. Sensation of fullness in the ear, ear feels plugged up or congested
  5. Nausea, feeling like you’re going to be sick or vomit

In some cases, people with Meniere’s can have sudden falls, sometimes called “drop attacks,” or Tumarkin’s otolithic crisis. You may feel like you’re falling, or the room is tilting around you, and the next thing you know, you’re on the floor. These falls are unpredictable and can cause injuries.

Medical Treatment for Meniere’s Disease

One of the common treatments for Meniere’s vertigo, ringing in the ears, or a sensation of fullness in the ears is the use of diuretics like Lasix, Diamox, or Dyazide, following the logic that they will help reduce the amount of fluid in the inner ear. However, there is not much scientific evidence showing that this method works for everyone, and diuretics may have other negative consequences, such as lowering blood pressure.

Anti-nausea medications, known as antiemetics, may offer some relief from nausea during bouts of vertigo. Histamines and their receptors are understood to be involved with signalling in the brain that may impact balance, so antihistamines, such as Dramamine and Benadryl, are often offered as a way to reduce dizziness. Again, there is not much evidence of the efficacy of antihistamines for vertigo. Drowsiness is a common side effect of taking antihistamines. Antidepressants are also sometimes prescribed to help with vertigo.

In rare instances, doctors may perform surgery to physically alter the inner ear; this is called labyrinthectomy. This may help reduce debilitating vertigo for some patients or help to prevent drop attacks, but for some people, it can cause even more damage to their hearing capabilities, and can even cause deafness. All of these medical treatments only try to reduce symptoms, they don’t help to prevent hearing loss due to Meniere’s disease.

Can Acupuncture Help Meniere’s Disease?

ringing in ear, dizziness, Meniere's
Acupuncture can help relieve ringing in the ear, dizziness, and nausea.

According to TCM theory, the sensation that the ear is clogged is related to a buildup of Phlegm, causing both physical obstruction and blocking the flow of Qi (energy). Dampness and Wind are other pathogenic factors that can contribute to Meniere’s symptoms of dizziness, vertigo, and the ringing or whooshing sounds in the ear. Weak Kidney energy, combined with Wind rising from the Liver, can cause dizziness, tinnitus, and headaches. An acupuncturist will listen carefully to find out which symptoms are arising, and when, and will choose acupuncture points on the head to directly address the obstruction in the ear, as well as other points on the body to address issues with Kidney Qi.

It may be helpful to make certain dietary changes to help address the excess fluid involved in Meniere’s disease, including reducing salt and sodium, and limiting caffeine and alcohol. Your acupuncture provider will discuss nutritional choices that will help to relieve Meniere’s symptoms.

One study of Meniere’s patients treated with acupuncture showed not only that their vertigo had subsided after a few treatments, but that their hearing levels were maintained rather than worsening as treatment went on.

Another study compared patients with Meniere’s who were treated with antihistamines to a group of patients who received acupuncture treatment for 12 weeks in addition to the antihistamine medication. The patients who received acupuncture reported significantly less vertigo and dizziness, less tinnitus, and actual improvements in their hearing over the patients who received medicine only.

A review of studies using TCM methods, including acupuncture treatment, moxibustion, cupping, and herbal supplementation, to treat Meniere’s disease found that symptoms of vertigo and dizziness were, by and large, greatly reduced, to the point of patients reporting their vertigo as being fully resolved.

A study in which patients were given acupuncture and herbs for 10 days resulted in a 95% effective rate, with the majority of people treated reporting no symptoms at all after the treatment, even after a two-year follow-up.

Acupuncture Near Me for Meniere’s Disease in West Los Angeles

Vertigo is a deeply unpleasant sensation, and never knowing when an attack of dizziness and nausea may strike can really disrupt your daily life. TCM has a proven track record of effectively helping people get over symptoms like dizzy spells and ringing in the ears, and may even help to prevent further hearing loss. If you know you have Meniere’s disease, or if you have some combination of these symptoms but aren’t sure what’s going on, it may be a good time to visit a qualified acupuncturist to see if acupuncture can help relieve dizziness due to Meniere’s, migraines, or BPPV.

 

 

*This article is for education from the perspective of Traditional Chinese Medicine only. The education provided by this article is not approved by FDA to diagnose, prevent, treat and cure human diseases. It should not stop you from consulting with your physician for your medical conditions. Traditional Chinese Medicine is based on Qi, which is an invisible force that usually cannot be observed by modern science. Because science focuses on testing ideas about the natural world with evidence obtained through observation, these aspects of acupuncture can’t be studied by science. Therefore acupuncture and Chinese herbs are often not supported by double-blind, randomized trials, and they are considered alternative medicine therapies in the United States.

Share

How to Treat PMS With Acupuncture and TCM

Share

By Xiaomei Cai, L.Ac., Ph.D. & Qineng Tan, L.Ac., Ph.D.

pms mood swings depression anxiety
PMS can cause mood swings, feelings of anxiety and depression.

Monthly mood swings, bloated stomach, headaches, and weight gain. Why is PMS so bad? Premenstrual syndrome (PMS) is a set of symptoms that occur in the days before a woman gets her period. PMS symptoms affect every woman differently, and can be serious enough to disrupt your life every month. TCM is an effective way to deal with PMS, because acupuncture treatment can help relieve both physical and emotional symptoms of PMS and severe PMS, also known as PMDD (premenstrual dysphoric disorder).

To say that PMS is common among women is an understatement. The vast majority of women experience some changes in both their mental health and their bodies the week before their period starts. Whether or not a woman feels that it has a negative impact on her daily life may change over time. For some women, PMS isn’t a big deal; for others, it’s a major problem that can affect their relationships, impact their work, and make life hell every month.

Most women find their own particular pattern of PMS is somewhat predictable–until it isn’t. One of the most frustrating aspects of menstrual problems is the sense that things change without warning, and symptoms can come on suddenly with ferocious intensity. It can be difficult to describe how you feel before your period, because the symptoms seem to come and go. Some women find that their PMS symptoms are different from month to month. In some cases, they might find that every other month is bad, while the alternating months aren’t so bad. Why is PMS worse some months?

Other than the basic understanding that PMS is caused by fluctuations in hormones and brain chemistry, conventional medical science does not offer much in the way of clear answers about what causes PMS.

TCM provides a different framework for looking at menstrual problems and has been used to treat women’s health issues of all kinds for many centuries. TCM treatments including acupuncture, acupressure, moxibustion, and Chinese herbs can not only help relieve PMS symptoms, they can also be beneficial for other menstrual problems like irregular periods, PCOS, painful periods, endometriosis, heavy periods, fibroids, and symptoms of perimenopause.

Top 10 Symptoms of PMS

As a syndrome, PMS is considered a collection of symptoms that often appear together, in various combinations in different individuals. In the case of PMS, a woman may feel that her own symptoms change as often as every month, or gradually over the course of years. Girls in their teenage years may experience PMS in one way. Then, a woman in her early adult years may develop a different set of symptoms. After having a baby, a woman may find that her PMS symptoms have changed again. Then, many women in middle age experience changes in PMS symptoms as they go through perimenopause, approaching menopause. The most common signs of premenstrual syndrome include:

  1. Mood swings, low mood, feelings of sadness or anger
  2. Anxiety, feeling tense and irritable, cry easily or lose temper, want to be left alone
  3. Trouble sleeping, insomnia, disturbed sleep
  4. Breast tenderness, sore breasts, swollen breasts
  5. Food cravings, changes in appetite
  6. Weight gain, stomach bloating, water retention, pelvic pressure
  7. Gassiness, changes in digestion and elimination
  8. Acne, skin problems
  9. Changes in libido
  10. Headaches, migraines, difficulty concentrating, foggy head

Less obvious or well-known symptoms of PMS include: vision problems, tingling in the arms or legs, lack of coordination (clumsiness, dropping things), bruising easily, heart palpitations, dizziness, itchy skin, cold sores, toothaches, back pain, joint pain, and increased TMJ jaw pain.

Other health problems can be amplified during the premenstrual period, such as: chronic fatigue syndrome, fibromyalgia, interstitial cystitis, migraines, IBS, Meniere’s disease (dizziness, vertigo), clinical depression and anxiety disorders.

The physical and emotional aspects of PMS can affect each other, causing the typical mood swings. Feelings of sadness and frustration, or lack of sleep, may lead to comfort eating, but then the sight and sensation of your bloated stomach can cause you to feel depressed about your body. Minor problems with your spouse or co-workers can suddenly seem overwhelming and make you feel angry or helpless. 

For some women, PMS symptoms are so bad that they feel unable to function the week before their period. Severe PMS is now diagnosed as PMDD.

What Is PMDD?

severe PMS PMDD
PMDD causes severe emotional symptoms.

PMDD (premenstrual dysphoric disorder) is a severe form of PMS marked by intense emotional symptoms that dramatically impact a woman’s life, in addition to physical symptoms. “Dysphoria” is the opposite of “euphoria;” in other words, it is a mental state characterized by profound unhappiness and negative feelings. It is estimated that about 5% of all women experience this extreme type of PMS. Signs of PMDD include:

  1. Severe anxiety, panic attacks, paranoia
  2. Severe depression, in some cases even suicidal thoughts, lack of self-worth
  3. Anger and irritability that provokes rage and causes conflicts with other people
  4. Fatigue, low energy, inability to concentrate, feelings of confusion
  5. Intense food cravings, possibly leading to binge eating

Again, there is currently no scientific answer for what causes PMDD, although it is generally believed to be related to the way estrogen levels and progesterone levels change between ovulation and the onset of the menstrual period. Mood is considered to be related to serotonin levels in the brain, and this is why PMDD is usually treated with birth control pills, which suppress ovulation, and/or antidepressants (SSRIs), which affect serotonin uptake.

Medical Treatment for PMS

birth control pills
Doctors often prescribe birth control pills to get rid of PMS symptoms.

Naturally, when a woman asks for advice about PMS or PMDD, she is going to hear suggestions like: “try meditating, exercise more, eat a healthy diet, and get more sleep.” And it is true that making good lifestyle choices is an important part of helping to reduce PMS symptoms. But women who are suffering with serious PMS need solutions beyond these kinds of lifestyle guidelines. 

When women complain of PMS symptoms, doctors will most often recommend OTC pain medications like ibuprofen or acetaminophen (NSAIDs) to relieve pain. Diuretics may be used to relieve bloating or premenstrual weight gain. Of course, most commonly, women are prescribed oral birth control pills, which suppress ovulation, and therefore may reduce the severity of PMS symptoms. More and more frequently, women may be prescribed antidepressants to try to deal with emotional symptoms and mood swings, or anxiety medications to take as needed during PMS. In effect, doctors often treat PMS the same way they would depression or anxiety. 

Clearly, birth control pills are not helpful for women who may want to get pregnant, and some women may be concerned about how taking the pill or antidepressants may affect their fertility in the future. None of these pharmacological solutions for PMS address the root cause of the symptoms, and all of these medications carry side effects that may impact a woman’s overall health. Health care for women with TCM seeks to address the deeper internal causes of hormonal imbalances and other problems with the organ systems that are impacting the health of the ovaries and the regularity of the menstrual cycle.

Can Acupuncture Help PMS?

yin yang PMS
When Yin and Yang are balanced, the menstrual cycle can flow smoothly.

While it is only in recent years that conventional medicine has begun to acknowledge connections between physical health and emotional health, TCM has understood for many hundreds of years that health conditions of all kinds, especially those related to the menstrual cycle, are rooted in the balance of energies. Menstruation represents an ongoing process of transformation that occurs not only within the reproductive organs, but which affects every part of a woman, and even the people around her.

The concept of Yin and Yang in Chinese philosophy describes two opposing yet complementary forces that are constantly acting upon each other in order to achieve balance. The menstrual cycle is very much based on Yin and Yang energies; during the follicular phase of the cycle (before ovulation), Yin is increasing while Yang is decreasing, and in the luteal phase (after ovulation, before the period), Yang is increasing while Yin is decreasing. The system is designed, naturally, to create the right conditions for conception; this process of Yin and Yang exchange is what determines a woman’s fertility.

While the health of the uterus and ovaries is definitely central to the process, within the TCM philosophy, they are not the only organs involved with menstruation. The Kidneys, Liver, and Heart all have important roles to play, as well. In TCM, we also view the elements of Fire–to provide warmth, controlled by the Heart–and Water, controlled by the Kidneys–to provide moisture, as being vital to all processes within the body, especially to menstruation. Blood is cleansed, stored, and then distributed to the other organs by the Liver. Blood being central to the process of menstruation, the Liver’s role is really key in how the whole thing plays out. 

According to TCM theory, most PMS and PMDD symptoms are caused by problems with Liver Qi. When the Liver Qi is out of balance, it can lead to feelings of anger, frustration, depression, and irritability. The Liver system is particularly susceptible to negative effects of stress.

There are a few different variations of Liver Qi imbalance and other patterns that can contribute to PMS symptoms:

  • Liver Qi invasion – This is a condition of excess, in which there is too much rising Liver Qi, characterized by overall negative emotions that are disruptive, including anger and anxiety, breast tenderness, headaches, dizziness, and constipation.
  • Liver Qi depression – In this case, there is not enough Liver Qi, causing feelings of sadness, heaviness in chest, painful swelling of breasts, sighing, bloated stomach, lack of appetite, cramping during period, scanty blood during period.
  • Spleen Kidney deficiency – In this case, stagnant energy in the Kidney system is preventing water from moving appropriately, causing water retention or edema.

From the scientific medical standpoint, acupuncture treatment has been shown to have a positive effect on neurotransmitters like serotonin, and to impact levels of estrogen and progesterone. This happens naturally because we are using TCM methods to restore optimal function of all the organs. With Chinese herbs we are able to get specific nutrients into the body that we cannot get from the foods we normally eat.

Acupuncture treatment accompanied with specific herbs for PMS patterns can help balance the liver Qi, and bring all of the organs into synergistic harmony.

In order to make lasting change, it is best to have acupuncture treatment at least once or twice a week. We need to deal with each phase of the menstrual cycle as it occurs by tailoring the acupuncture treatment and herbs to your PMS and period symptoms. 

A systematic review of ten controlled trials using acupuncture to treat PMS concluded that TCM treatment of PMS significantly improved symptoms.

Top 3 Tips for PMS Relief From TCM Perspective

yoga tai qi pms period gentle exercise
Gentle exercise to get Qi moving can help with PMS symptoms.

There are still a lot of taboos surrounding women’s health, and many girls and women have never learned how to take care of their reproductive health. Working with an experienced TCM doctor will enable you to get personalized care and advice about how to eat the best diet for PMS symptoms, what activities to avoid before your period, and other female hygiene tips that you may not have heard before. 

  1. Nutrition – conventional Western thinking about healthy eating currently focuses on eating fresh, whole foods, which is good, except that people tend to think this means eating a lot of foods raw or cold, as in salads and smoothies. According to the TCM philosophy of nutrition, though, eating cold foods is actually one of the worst things you can do when it comes to relieving PMS and painful periods. Putting a lot of cold food into the stomach cools down the temperature of the other internal organs, which can contribute to more cramping and worse cramps. During the week before your period, concentrate on eating plenty of nourishing, cooked foods like soups and stews, proteins and vegetables, and whole grains like brown rice and quinoa. Avoid too much dairy, sugar, caffeine, hot, spicy or fried foods (that includes chips and crackers), and definitely avoid icy cold beverages and frozen treats.
  2. Keep track of your period – there are many apps available now to help with this, but it can also be a simple chart with room for notes about your symptoms. Keeping track of your PMS symptoms every month can help you recognize patterns in your own behaviors and experiences. A record of PMS symptoms will also help you communicate what you’re feeling to your health care providers when you are seeking treatment for PMS or PMDD.
  3. Exercise – gentle movement modalities that move Qi through the body are great to help PMS: Tai Qi, yoga, or dancing are all good. Avoid deep twists that could squeeze or put pressure on the ovaries and other organs. Again, keep track of your exercise routines and how they affect your physical and emotional wellbeing from month to month so that you can see which type of workout is best for you, or if some types of exercise make PMS worse.

Acupuncture Near Me for PMS in Los Angeles, CA

Many women come to us at Art of Wellness seeking help with menstrual problems or fertility issues. We have over 30 years of experience in helping to relieve symptoms of PMS and all types of period pain and dysfunction. It is possible for the menstrual cycle to flow without extreme feelings or strong physical discomfort. If you feel like PMS or PMDD is negatively impacting your life every month, please do not hesitate to give us a call. 

 

 

*This article is for education from the perspective of Traditional Chinese Medicine only. The education provided by this article is not approved by FDA to diagnose, prevent, treat and cure human diseases. It should not stop you from consulting with your physician for your medical conditions. Traditional Chinese Medicine is based on Qi, which is an invisible force that usually cannot be observed by modern science. Because science focuses on testing ideas about the natural world with evidence obtained through observation, these aspects of acupuncture can’t be studied by science. Therefore acupuncture and Chinese herbs are often not supported by double-blind, randomized trials, and they are considered alternative medicine therapies in the United States.

 

 

 

Share

How to Treat Painful Periods With TCM and Acupuncture

Share

By Xiaomei Cai, L.Ac., Ph.D., & Qineng Tan, L.Ac., Ph.D.

woman in pain
Severely painful periods could be a sign of endometriosis.

Our patients often ask us these questions: Why do I have heavy periods with severe, painful menstrual cramps that seem to be getting worse and worse? Why do I have spotting in between my menstrual periods? My ovaries hurt, I feel abdominal pain after sex; it even hurts to go to the bathroom. Excruciating period cramps, or period back pain during any part of the menstrual cycle, may mean a woman has endometriosis. Endometriosis is when menstrual tissue grows in places it shouldn’t. Acupuncture and TCM can help provide menstrual cramp relief, restore normal periods, and boost fertility.

Endometriosis is a fairly common condition, affecting about one in ten women during their reproductive years (age 15-49). If it goes untreated, endometriosis not only causes serious pelvic pain in women (pain lower abdomen), but can create a lot of scar tissue on the abdominal organs, negatively impacting fertility, and sometimes even continuing to cause problems after a woman has gone through menopause and no longer has a menstrual cycle. 

What is Endometriosis? The thick, bloody lining of the uterus that develops every month–with the ultimate purpose of possibly nourishing a fetus, should a woman become pregnant– normally breaks down and flows out during the menstrual period. When a woman has endometriosis, this same tissue develops in places other than the inside of the uterus: on the ovaries or fallopian tubes, on the outside of the uterus, or even on the intestines or bladder. The overproduction of hormones created by this excess tissue is partly what causes painful periods, as well as internal bleeding.

Current conventional Western medicine generally treats endometriosis using pain medicine and oral birth control pills or Nupron, a drug that suppresses estrogen production, to control bleeding. Nupron prevents the period from coming, so it controls most of the menstrual pain of endometriosis and prevents the further growth of menstrual tissue. However, when a woman stops taking these hormone suppressant medications, the condition will most likely come back. Surgery can remove patches, nodules, and cysts, but endometriosis can still come back easily when the root cause has not been addressed. TCM gives us a way to treat and prevent endometriosis at its source, at the same time as providing natural pain relief.

Top 10 Signs and Symptoms of Endometriosis

The symptoms of endometriosis can be serious and debilitating, especially when a woman has her menstrual period. However, the pelvic pain and excessive bleeding associated with endometriosis can occur at any time during the month. 

  1. Severely painful menstrual cramps (dysmenorrhoea)
  2. Heavy bleeding during period; period lasts a long time
  3. Spotting in between periods
  4. Pain during ovulation (mittelschmerz); pain in lower right abdomen, pain in lower right side, pain in lower left abdomen, pain in lower left side
  5. Pain during or after sexual intercourse (dyspareunia)
  6. Pain when urinating or defecating, perineum pain
  7. Chronic pelvic pain
  8. Chronic low back pain, hip pain
  9. Fatigue
  10. Infertility
woman crouching in pain
Endometriosis can cause terrible pain, infertility, and depression.

The severity of pain does not necessarily correspond to the size or spread of the endometrial tissue. Small nodules can cause severe pain, while massive adhesions or large cysts can cause minimal pain. Pain can occur any time, not only during menstruation. 

Endometriosis can have a significant impact on a woman’s quality of life. Not only is the constant, serious pain exhausting, but painful sex, low libido, and anxiety about fertility can put a strain on relationships. A woman with endometriosis may also experience depression. The severe pain caused by endometriosis should not be ignored, as the condition can cause lasting damage, not only to the reproductive organs, but potentially also to the digestive organs and other abdominal tissues.

Endometrial patches or lesions may respond to the stimuli of the female hormones produced by the ovaries, causing them to become inflamed and/or shed bloody tissue during the menstrual period. During the period, the uterus bleeds, and the other patches of tissue bleed, too. They can also begin to produce their own hormone secretions, causing them to bleed at irregular times. This tissue can cause organs in the pelvis to “stick” to each other and create scar tissue or nodules on the organs over time. 

Endometrial patches can grow nerve tissue, as well, which produces the intense sensations of pelvic pain, abdominal bloating, and cramps. Women with endometriosis often have cysts on the ovaries, because the endometrial tissue outside of the uterus responds to hormones. The body absorbs water from these cysts, and the bloody tissue turns into a thick, syrupy, brown liquid; this is why they are sometimes referred to as “chocolate cysts.”

When a woman has endometriosis, she almost always shows compromised hormone issues, in addition to menstrual pain. The cycle is off, usually showing luteal phase deficiency– when the luteal phase is 12-14 days instead of the typical 14 days from ovulation to the start of the period. This is due to ovarian cysts affecting the function of the ovaries.

Patches or nodules can also form in other parts of the body, in rare cases, causing nosebleeds or chest pain because tissue has migrated outside the pelvic area.

What Causes Endometriosis?

The causes of endometriosis are not currently understood by medical science. Women whose mothers or other female relatives have had endometriosis do seem to have a higher risk for having it themselves, so it is possible that there is some genetic marker that causes some cells outside the uterus to develop into endometrial cells. The most likely theory is that a backflow of some menstrual blood travels into the fallopian tubes and from there migrates into other areas of the pelvis, and in some cases, even other parts of the body. 

birth control pills
Birth control pills may help control bleeding, but they aren’t a cure for endometriosis.

Many women have a hard time finding a proper diagnosis for their endometrial pain. Menstrual pain has been normalized to such an extent that it is often ignored, or just accepted, by both doctors and patients. Usually many other possible causes of the pain have to be ruled out before a woman is offered diagnostic testing especially for endometriosis. The usual type of pelvic exam is generally not helpful for spotting endometriosis. Ultrasound may detect large lesions, but imaging is not clear enough to see all endometrial growth. Getting a confirmed diagnosis involves a somewhat invasive laparoscopic procedure to detect cysts, lesions, or scar tissue. This is unfortunate, because early detection is the best way to prevent endometriosis from spreading and getting worse.

Conventional treatment for endometriosis focuses mainly on pain management with analgesic medications, and using hormones (birth control) to prevent further growth. Clearly, this is not helpful for women who want to get pregnant. When a woman is concerned with her fertility, and wants to conceive, then laparoscopic surgery to remove growths may be indicated. 

How Does Acupuncture Treat Endometriosis?

According to TCM theory, endometriosis is considered a form of blood and Qi stagnation. We might classify this type of problem as Zheng Jia, in which blood stasis causes clotting or the formation of masses. PCOS, ovarian cysts, uterine fibroids, and reproductive cancers would also fit in this category. Other patterns can also cause dysmenorrhea (painful periods) and contribute to endometriosis.

Problems with the female reproductive system can present in a variety of ways:

  • Qi stagnation with blood stagnation
  • Yang deficiency with blood stagnation
  • Qi sinking with blood stagnation

The reason for stagnation can be a blockage of liver Qi, often associated with feelings of anxiety. This is why stress management is so important. Blockages can also be caused by being in a cold environment, not dressing warmly enough, or drinking or eating cold things during the menstrual period. During the period, the organs need to be open; allowing the pelvic area to become too cold can restrict the flow, create stagnation, and contribute to the development of cysts, endometriosis, and/or fibroids.

moxibustion
Moxibustion cultivates heat energy

Carefully considering the overall presentation of symptoms, an acupuncture practitioner will seek to determine the root cause of the Qi and blood stasis and develop a treatment protocol aimed at clearing stasis, increasing circulation, nourishing the uterus and ovaries, and regulating dysfunctional energies in other organs, such as the liver, kidneys, and spleen. Moxibustion may also be used to help bring heat energy to areas where stasis is caused by cold.

Acupuncture treatment in conjunction with individually formulated Chinese herb supplements and other modalities such as cupping is used to help move Qi and blood. Herbs help to bring in nutrients that people would not otherwise get in their diet; nourishing the ovary follicles, in particular, is vital for helping women with endometriosis overcome infertility problems.

A clinical trial at a hospital in China compared two groups of women with endometriosis: one group was given the synthetic steroid mifepristone, intended to reduce progesterone action. The other group was treated with acupuncture and herbs. The patients were checked via ultrasound to detect progress. The efficacy rate for reduction of endometrial growth was the same in both groups, suggesting that TCM methods were just as effective as steroids for improving the symptoms of endometriosis and halting its spread.

A systematic review of ten trials concluded that acupuncture treatment was effective for reducing endometriosis pain. 

Both of the studies cited here also noted, via blood tests, a reduction in CA-125 levels in the women receiving acupuncture. Elevated CA-125 is a marker not only for more advanced stages of endometriosis and increased pelvic pain, but also for various types of female reproductive cancers. 

Keep in mind that the effects of acupuncture treatment are cumulative; more benefits will be felt with regular treatment. There is no cure for endometriosis, but acupuncture and TCM can help significantly reduce pain,  prevent the further development of endometrial tissue and scarring, and help improve fertility for women who want to start a family. 

TCM not only treats symptoms and pain, but helps relieve stress, and increases the flow of Qi and blood, helping to manage all aspects of female reproductive health.

During childbearing age, the best way to help get rid of or manage endometriosis is to carry a pregnancy to term, because during pregnancy there is no period. When the ovaries and menstrual cycle get ten or so full months of resting time, there is a good potential for cysts, nodules, and lesions to go away. Good care will rid the body of the stagnation. Acupuncture and TCM allow us to treat endometriosis and infertility simultaneously, if pregnancy is a woman’s goal.

Top 5 Tips for Natural Relief of Endometriosis

acupressure point for menstrual cramps
Apply gentle pressure to help relieve painful cramps.

In addition to acupuncture and TCM treatment, here are some natural remedies for endometriosis pain that you can try at home:

  1. Apply heat – warming energy can help relieve the painful symptoms of endometriosis. An electric heating pad, hot water bottle, or sock filled with rice and heated in the microwave, then applied to the abdomen or lower back can help relieve cramps.
  2. Drink plenty of water – dehydration intensifies cramping, so be sure to sip clean water throughout the day. Warm water particularly can help to thin the blood and keep it flowing smoothly.
  3. Plan ahead to give yourself extra down time – tracking your cycle and symptoms is important. When you know ahead of time that you are likely to be experiencing pain, plan to give yourself time off to rest. Taking extra pain medications or pushing through pain will only cause more exhaustion and anxiety.
  4. Period care – we recommend you use pads or period underwear more often than tampons during the menstrual period; use tampons only when the situation requires it (swimming, etc.). Also, do not engage in sexual intercourse during the heavy flow days of the period. Avoid anything that could block or reverse the flow of menstruation.
  5. Avoid caffeine and alcohol – some studies have shown that women who consume more of these substances are at higher risk for endometriosis (and many inflammatory conditions). While this doesn’t mean there is a direct link, it is still better to keep your intake of coffee and wine to a minimum. Avoid toxins in your food – food additives, pesticides, and chemicals in meat can trigger endometriosis symptoms. Focus on eating whole, natural foods and getting plenty of healthy Omega-3 fats from nuts, avocados, and high-quality fish or plant oils.

Above, there is also a good acupressure point to use when you are having painful cramping during menstruation, or to help relieve nausea from morning sickness.

Acupuncture Near Me for Endometriosis

At Art of Wellness, we have over 30 years of experience in managing women’s health issues. Our education and early practice gave us the opportunity to work with leaders in cutting-edge integrative medicine for women. Since 1997, we have worked with the top infertility ART providers in Los Angeles to give women the best in reproductive health care and fertility treatment. If you or someone you know is struggling with the pain of endometriosis or infertility, do not hesitate to call us and get started with an initial consultation.

 

*This article is for education from the perspective of Traditional Chinese Medicine only. The education provided by this article is not approved by FDA to diagnose, prevent, treat and cure human diseases. It should not stop you from consulting with your physician for your medical conditions. Traditional Chinese Medicine is based on Qi, which is an invisible force that usually cannot be observed by modern science. Because science focuses on testing ideas about the natural world with evidence obtained through observation, these aspects of acupuncture can’t be studied by science. Therefore acupuncture and Chinese herbs are often not supported by double-blind, randomized trials, and they are considered alternative medicine therapies in the United States.

Share
310-451-5522 Directions Contact/Schedule