By Mary Elizabeth Wakefield, LAc, MS, MM, DiplAc (NCCAOM)
Scars are the causes of prolonged effects that an injury continues to have on the body. Despite the outward appearance of healing, patients continue to suffer from the residual impact of scar tissue formation long after the initial trauma, and experience chronic pain and disability, both physical and psychological. They find little relief from conventional treatments.
Western medicine is particularly effective when addressing the impact of acute trauma, but medical orthodoxy regards the formation of a scar as the end result of the process, rather than an interim phase on the road to a more complete recovery from the injury. Consequently, there are few strategies in place for alleviating the long-term effects of these disturbances of the skin and underlying tissues.
Japanese scar therapy has a well-established tradition of effectively treating scars; it lessens pain, regenerates the nerves and tissues, and dissolves the adhesions that encroach upon organs, tissues and muscles. Acupuncture needling increases circulation and facilitates greater nutrition and oxygenation of the cells in the affected area.
The English word scar is originally derived from the ancient Greek root “eskhara”, which means “hearth” or “fireplace”. Medically, the scar (escher) arises in the aftermath of a wound caused by burning or other injuries. Scars develop during the natural biological processes of wound repair; they are composed of collagen, but the constituents of the fibers that form within the scar are different. Instead of the basket-weave formation of normal, soluble fibrinogen, scar tissue contains insoluble strands of fibrin that are less functional. As a result, the skin becomes inflexible and often sweat glands and hair follicles do not reappear in that area.
Scars have a variety of different manifestations: they can be raised, flat, short, round, pink, purple, flesh-toned, or brown in color. Scar formation depends upon the color and type of skin, health, genetics and age of the patient.
Types of Scars
Over-expression of, or excess, collagen is characteristic of hypertrophic and keloid scars. Both of these scar types are comprised of excessively stiff collagen bundles that inhibit the regeneration of healthy tissue.
A hypertrophic scar is elevated above the surface of the skin, and forms in direct proportion to the size of the wound. The excessive collagen gives rise to a raised scar. This type of scar develops at the site of pimples, piercings, cuts, and burns, and often contains nerves and blood vessels.
Hypertrophic scars generally are seen after a burn, surgery or other traumatic injury that impacts the dermal layer of the skin. A keloid scar is similar to a hypertrophic scar, but it extends beyond the boundaries of the original wound.
Atrophic scarring occurs due to the under-expression of collagen, and generally manifests as a sunken area, which can be characterized as “kyo”, a Japanese shiatsu term meaning an empty, deficient space in the tissue. I would describe it as a “valley” – recessed and yin.
Conversely, hypertrophic and keloid scars are “jitsu”, referring to the overproduction of collagen in the tissues. They are excess and yang, mirroring the “mountains” which surround the valley.
Let us examine in more detail these types of scars:
Hypertrophic scars are hereditary in nature, and present as red, raised lumps on the skin, and generally appear about 4 to 8 weeks after the injury. Japanese scar therapy can help to alleviate the condition of the scar, flattening it out, and causing it to appear less red and inflamed.
Keloid scars are composed of Type III collagen, which is more inflexible than Type I. Keloids are firm, rubbery lesions or shiny, fibrous nodules, which vary in color from pink to red or dark brown in color. While they may have the appearance of tumors, they are nevertheless benign and non-contagious.
Keloids may also be itchy and painful, and impede movement of the skin; they are 15 times more prevalent in individuals with dark skin. If they become infected, they can form ulcerations; the collagen overgrows the wound area and produces lumps.
Atrophic, “sunken” scarring is characterized by depressions in the skin, the result of collagen bundles that do not overextend the tissue. For example, stretch marks, striae, can be regarded as atrophic, and occur when the skin is stretched in a comparatively short period of time, as during pregnancy, periods of excess weight gain or loss, or adolescent growth spurts.
A pitted appearance in the skin is due to the atrophy of underlying structures like fat or muscle; this phenomenon is associated with acne, chicken pox, surgery, accidents, or stretch marks.
Scar therapy is effective in ameliorating chronic pain, and it additionally addresses the psychospiritual dimension of the wound – the memory of the trauma, surgery or accident. While the conscious mind may not necessarily have access to the actual details of the event, particularly under general anesthetic, the body has experienced the trauma or invasion on a deep level, and cannot feel itself to be balanced and healed because of the loss of its integrity. Thus, the scar which eventually forms is a constant irritant, a perpetual reminder of the violation and organic damage.
Physiological factors affecting healing:
- Prolonged trauma
- Clotting tendencies
- Tissue regeneration
- Strength of immune system;
- Emotional and environmental stress
- A combination of non-elastic tissue, insufficient blood supply, & oxygen/nutrient deprivation to the affected area can cause adhesions;
- Localized adhesions pull on the surrounding tissues and can affect digestion, circulation and respiration;
- The functioning of muscles and organs in the area can become impaired; the scar serves as an ongoing source of irritation to the body, and a reminder of the initial damage;
- By needling the scar, one can break up scar tissue, increase circulation, oxygenate and improve cell nutrition;
- Scar adhesions pull on muscles and organs, compromising the body’s functioning;
- Adhesions cause stress and make the body aware of previous traumas, surgery, accidents or damage;
- Scars do not change after 10 days; begin with treatments after 10 days. Do not treat them if they are infected or ulcerated;
- Cellular memory: in treating adhesions, the patient may remember the trauma associated with the formation of the scar;
- This remembrance may cause an emotional release;
- According to Kiiko Matsumoto and her senseis, If the scar or old injury has not completely healed, the adhesions will contribute to the appearance of secondary symptoms, ones that would seem unrelated to the original injury or area of surgical intervention; for example:
|Type of Scar||Secondary Symptoms|
|Face lift surgery;
SCM injury causes autoimmune and nerve disturbances.
|autonomic nerve imbalances
heightening of distress associated with PMS
hyperdiaphragm; difficulties with inspiration of breath
|Hysterectomy; Dantien disturbance, Ren/Chong Mai, plus Kidney meridian disturbances||sciatica
spasms of the ileocecal valve
sensation of constant bladder infection
ache in the lower back (quadratus lumborum muscle)
|Figure 1. Ankle surgery: scar needling increased circulation and oxygenation of the tissues|
- Note the color of the scar;
- Palpate cross-fiber over the scar; feel for both raised areas (jitsu) and indented areas (kyo) within the scar;
- Palpate and find the edges or terminators of the scar;
- Please ask your patients for feedback regarding the following: is the scar, numb, tingly, painful, or uncomfortable to the touch?;
- First, needle the two terminations of the scar, horizontally and superficially, from each end toward the center. Needle just under the scar to break up the adhesions;
- Then, needle directly under the scar, cross-fiber, where you detected the raised (jitsu) or indented (kyo) areas;
- Needle only in the location where the adhesions seemed the most prominent;
- Continue these scar treatments every week, integrating them into your patient’s treatment protocol;
- The time required for scar therapy treatments depends upon the age of the scar:
|Figure 2. Old scalp injury: the hair follicles have not grown back|
- Old scars will respond gradually to the acupuncture needling; for example, with a 25-year old hysterectomy scar, you may have to wait 6 months to a year to observe noticeable results;
- You will know that the treatments are working because the adhesions will smooth out. The residual numbness, and the secondary symptoms, such as incontinence, will be relieved or lessened;
- A new scar, 11 days old, caused by the removal of a skin cancer, melanoma, from the face, should respond within one month, if the patient is healthy;
- Use longer and thicker gauge needles for abdominal scars and smaller, thinner gauge, needles for the face;
- Note that upper lip lines can relate to abdominal scarring.
I have found that horizontal lines on the upper lip are often associated with a hysterectomy performed during the child-bearing years, due to the presence of fibroids, endometriosis or uterine cancer.
This line can also indicate a Caesarian section, sterility in both men and women, a head trauma, or scarring of the uterus by an intrauterine device (IUD).
Since, according to Chinese physiognomy, the upper lip relates to the sexual organs, and the philtrum of the upper lip, to longevity, I usually ask to examine the abdominal scar that has resulted from the Caesarian section or hysterectomy. I then use Japanese scar therapy distally to release the adhesions, instead of needling the sensitive area on the upper lip. In needling the abdominal scar, the upper lip line becomes very red and full of fresh blood and qi circulation. There are several benefits that can be achieved in treating the abdominal scar:
- The upper lip is sensitive, and needling it locally will cause the patient some discomfort.
- Needling the abdomen affects the upper lip and sexual organs, and treats the cause, rather than the symptom.
- Some scars are horizontal, just above the pubic bone, and others are vertical, lying along the ren mai meridian, which disturbs its flow. Needling these abdominal scars breaks up adhesions, and will help to reestablish the free flow of qi in the meridians. For example, a horizontal scar above the pubic bone blocks not only the ren mai, but also the kidney, stomach, and spleen meridians, and will cause constitutional imbalances.
- An untreated scar in this area will cause secondary problems because the adhesions pull on the organs, muscles and tissues. For example, a horizontal scar can pull on the bladder, causing frequent urination, a constant feeling of fullness, and incontinence. By needling this area, the symptoms will cease in time.
It is important to note that by treating an abdominal scar distally, you can evoke constitutional shifts, and that the associated horizontal upper lip line should fade within the course of treatments.
When teaching a seminar some years ago, I noticed a small circle above the right side of a student’s upper lip. When I asked her if she had an abdominal scar, she showed me a circular incision on the same side, from a recent tubal ligation. When I treated the scar by Surrounding the Dragon with small intradermal needles, the circle on the upper lip turned bright red, mirroring the increased circulation in the abdominal area. Several months later, the scar had vanished.
After you’ve needled the scar, apply vitamin E, or the essential oil blend for scars that I have provided below, to the skin. Use a cotton ball or cotton bud to apply the scar oil. It will be readily absorbed into the skin and dissolve adhesions. Have your patient use the scar oil at home, twice daily.
Scar Oil: for scars, acne scars, burns, sun damage, mature skin, and dry skin
20 drops lavender essential oil
10 drops carrot seed essential oil
15 drops helichrysum essential oil
6 tablespoons rosehip seed oil
2 tablespoons calendula oil
2 tablespoons jojoba oil
1 teaspoon vitamin E oil
Combine lavender, carrot seed, and helichrysum in a cobalt blue bottle with the carrier oils – rosehip seed, calendula and jojoba oils. Then, add vitamin E to the essential oil mixture, and shake the bottle. Apply to scar tissue 2 times daily.
Lavender (Lavandula augustifolia)
|Qualities:||Reduces scars, treats insect bites, burns and sun damage|
Carrot seed (Daucus corota)
|Qualities:||Treats scars and hyperpigmentation|
Helichrysum (Immortelle) (Helichrysum augustifolia)
|Qualities:||Cellular regenerator; heals scars|
Recommended treatment modalities:
- Myofascial release
- Qi gong
- Tuning forks (vibrated on the scar to break up adhesions)
- Moxa: pole moxa, Tiger warmer; thread moxa for old scars
- Mustard and castor oil packs; for old scars
- Internal scarring: nattokinase (fermented soybean), and silkworm extract
- Topicals: vitamin E, scar oil, Biosil for scars and stretch marks; silicon sheeting over large scars
- Homepathic: Silica 30C; tissue salts: Calc P
Our skin is a vulnerable, surprisingly resilient organ, and yet it retains the memory of the wounds that we have suffered, both on a physical and psychospiritual level.
It plays many roles in our lives and is remarkably intelligent and versatile. This permeable sheath selectively keeps some things in and some things out of the body. For example, it protects us from the environment and shields the internal organs from external pathogenic influences such as ultraviolet rays and attacks from chemical, microbial, or other physical agents. It also regulates blood pressure and cools body temperature while detoxifying the system via the evaporation of sweat.
Our skin is constantly evolving as new cells die and others form. It telegraphs information about us to others: our state of health, age, ancestry, genetics, sex, habits, our balances and imbalances. With each line etched on our face, we communicate to other skins what emotions we hold within us, how we express ourselves, think, and live our lives.
The skin ages, scars, has birthmarks, piercings, wrinkles, warts, moles – and yet it rarely fails us. It is a brilliantly designed organ that is constantly being renewed and transformed.
Mary Elizabeth Wakefield, LAc, MS, MM is the internationally recognized author of Constitutional Facial Acupuncture, an Acutonics® and Zen Shiatsu practitioner, a cranio-sacral therapist, and a professional opera singer. With 30+ years of clinical professional experience as a healing practitioner, she has personally trained close to 6,000 healthcare practitioners from five continents in her treatment protocols. She and her life and teaching partner MichelAngelo recently published a new book, Vibrational Acupuncture: Integrating Tuning Forks with Needles. Mary Elizabeth maintains a private practice on the Upper East Side of Manhattan, in New York City.
 Wakefield, Mary Elizabeth, Constitutional Facial Acupuncture, Elsevier, UK, 2014, pp. 225-226.