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69. Occipital Headache, How Can Acupuncture Treat It?

Mar 7, 2017   //   by drxuacupuncture   //   Blog, Case Discussions, Uncategorized  //  No Comments

News Letter, Vol. 8 (2), March, 2017, © Copyright

Jun Xu, M.D., Hong Su, C.M.D., Lic. Acup.

www.drxuacupuncture.co

Rehabilitation Medicine and Acupuncture Center

1171 East Putnam Avenue, Building 1, 2nd Floor

Greenwich, CT 06878

Tel: (203) 637-7720

How Can Acupuncture treat Occipital Neuralgia?

 

Linda, a 45-year-old female dental assistant, came to me complaining of severe headaches that started at the back of her head and continued down a portion of her neck.  The pain also radiated up to her scalp, around her ears and sometimes into the bilateral temporal area.  The pain was off-and-on, but occurred every day.  The pain ranged from dull to sharp, and was sometimes located directly behind the right eye.  As a dental assistant, she constantly turned her head to the right when dealing with patients.  This caused the headache to become more severe, and she was frustrated that it interfered with her daily work.  She had consulted several doctors about her condition, and had been prescribed Naprosyn, Percocet and Neurotin, but none of them alleviated her condition.

These headaches intensified when Linda was under stress, which was often because of her job: if she had many patients waiting for her and felt under pressure, the headaches worsened.

When I examined Linda, I discovered that when I pressed her scalp at the base of the skull and suboccipital area, the pain radiated to the back, front and side of her head, and also to the right side of the eye.  When I pressed hard on the suboccipital area (the base of the skull) the pain was exacerbated and I could feel the bilateral temporal artery palpating.

The patient probably suffers from occipital neuralgia, which is a cycle of pain spasms originating in the suboccipital area, caused by an inflammation of the occipital nerves.  The two pairs of occipital nerves (each nerve contains a greater and lesser occipital nerve) originate in the second and third vertebrae of the neck.  These nerves supply areas of the skin along the base of the skull and behind the ear, but are not always connected directly with the structures inside the skull. However, they do interconnect with other nerves outside the skull and continue into the neuro-network.  Eventually they can affect any given area along the scalp, mainly on the bilateral temporal area behind the ear and sometimes connect to the nerve branch on either side of both eyes.

Occipital neuralgia may occur continuously, often as the result of the nerve impingement, especially from arthritis, muscle spasm, or as the result of a prior injury or surgery.  Sometimes these conditions will impinge the occipital nerve root, leading to severe headaches at the back of the head, leading to muscle spasm.  Linda exhibits the severe form of occipitical neuralgia, most likely because her profession causes her to tilt her head in the same manner for a good part of her day. This stress causes the occipital nerve to be impinged, sending a constant signal to the nerve network in her scalp, leading to headaches and the pain behind her right eye.

The clinical diagnosis of this condition is based on palpation by the doctor of the bilateral occipital nerve root, which will induce or trigger the headache. Doctors currently use various treatments.  One option is to inject 1% lidocaine 5cc into the occipital nerve root, which decreases or relieves the pain, confirming the diagnosis.  A second option is to use surgery to cut or burn the nerve with a radial wave probe.  A third option is to use a small injection of Botox or a similar medication.  Western medicines include anti-inflammatory or narcotics such as Percocet or Darvocet, Naurontin, anti-epilepsy medication, etc.  For the majority, these medications do not work well, though occasionally they can reduce the occurrence and frequency of the occipital neuralgia.

Some patients respond to physical therapy and massages to decrease the spasm of the neck muscle, which might temporarily relieve the occipital neuralgia.  Though doctors may recommend surgery, many patients resist this type of treatment.

According to Traditional Chinese Medicine, occipital neuralgia belongs in the category of the side headache, i.e. the Shao Yang Gallbladder meridian headache.  Gallbladder meridians are distributed around the sides of the head, and excessive heat in the gallbladder can lead to headaches.  The gallbladder meridian originates from the outside of the eye, and continues up the temporal nerve area, around the lateral skull area, down the occipital nerve area, down through the trunk and to the outside of the leg.  If there is excessive heat along this meridian, there will be an imbalance of yin and yang.  For example, if the patient undergoes stress, muscle spasm or arthritis, the nerve and the gallbladder meridian will be impinged.  This, in turn, will cause the gallbladder to heat up, leading to excessive heat, an imbalance of yin and yang and a severe headache.

Another meridian identified in occipital neuralgia by Traditional Chinese Medicine is the urinary bladder meridian, which starts from the inside corner of the eye, continues through the middle and the top of the scalp, and follows down the back of the trunk and into the back of the leg.  Due to the connection between the gallbladder and urinary bladder meridians, heat in one will cause heat in the other to rise, generating pain around the eye, the temporal area and the scalp, and making the ensuing headache severe and highly unbearable.  Therefore, the principal acupuncture treatment is to relieve this excessive heat in the gall bladder and urinary tract.

The main acupuncture points used for treatment are: Du 20 Bai Hui, GB 20 Feng Chi, GB1 Tong Zi Liao, GB 8 Shuai Gu, Extra point Tai Yang, GB 34 Yang Ling Quan, SI 3 Hou Xi, Lu 7 Lie Que, Kid 6  Zhao Hai, Li 3 Tai Chong.

Linda underwent my treatment three times a week for one month, resulting in immediate, short-term relief of her headaches.  However, the headaches continued to plague her because of her strenuous work.  In addition, her irregular menstrual cycle and hormonal changes led to more severe headaches.  Thus, I also treated her for hormonal changes by utilizing a Chinese herb Da Zhi Xiao Yao San.  The combination of acupuncture and herbal therapy seemed to be effective and, after about two months of treatment, Linda reported that her headaches occurred only infrequently and were very mild, and that she was satisfied with her treatments.

Usually, acupuncture, with or without the addition of herbal supplements, can alleviate the problems and pain associated with these headaches.  However, sometimes it is best to combine acupuncture with a nerve block (utilizing 4cc of 1% lidocaine plus 10 mg Kenalog mixed together) injected into both sides of the occipital nerve origin.  One month of this combined treatment should give the patient 95% relief from his/her symptoms.

Tips for acupuncturists:

  1. You should identify the location of the pain and tenderness, and treat the headache accordingly.  For example, the frontal headache belongs to the Yang Ming meridian; the temporal side headache belongs to the Shao Yang meridian; the top scalp headache belongs to the Jue Ying meridian.
  2. Always use Du 20 Bai Hui for all the different types of headaches. This is based on my personal experience over 20 years of practice.

Tips for patients:

  1. You should be very specific when describing the tender points on your head because each tender-point location belongs to a different meridian, and treatment varies based on each location.
  2. Massaging the Tai Yang and UB 20 Feng Chi points for 20 minutes, 2 to 3 times a day, will greatly decrease the headache.

 

68. An Ancient “New Way” to use Acupuncture to treat Cervical Dystonia

Mar 7, 2017   //   by drxuacupuncture   //   Blog, Case Discussions, Uncategorized  //  No Comments

News Letter, Vol. 8 (1), March, 2017, © Copyright

Jun Xu, M.D. Lic. Acup., Hong Su, C.M.D., Lic. Acup.

www.drxuacupuncture.co

Rehabilitation Medicine and Acupuncture Center

1171 East Putnam Avenue, Building 1, 2nd Floor

Greenwich, CT 06878, Tel: (203) 637-7720

Cervical Dystonia




Lisa L. is an 18-year-old female, who had been complaining of neck pain for the past six years.  The patient reports that, six years ago, when she woke up, she suddenly realized that her neck jerked to the left. The jerk happened very often; her neck would jerk two or three times every 5-10 minutes.  The jerk was involuntary and occurred more frequently especially when she was tired or under stress. However, if she had a good night’s rest, felt energized, and focused on something (e.g. her favorite sports), she would not experience the sudden, involuntary neck movements. Only when she sat still, did her neck start to jerk.

Lisa’s neck muscle always feels very tight, and the tightness can be very painful. She has been to many doctors and has tried everything, such as physical therapy and multiple medications, without any improvement. She therefore came to me for evaluation and treatment. Upon physical examination, I noted that the left side of the patient’s sternocleidomastoid muscle had hypertrophied. It felt like a thick rope on the left side of her neck. I also noted that other muscles had undergone hypertrophy: the levator scapular and splenius capitis at the cervicals. Throughout the entire physical examination, there was no jerk or involuntary contraction on the left side of the patient’s neck.

What Lisa is suffering from is called cervical dystonia, which is the most common form of focal dystonia.  Cervical dystonia is characterized by abnormal and spasmodic squeezing of the muscle that leads to muscle contractions in the head and neck area. The movements are involuntary and are sometimes very painful, causing the neck to twist repetitively, resulting in abnormal posture.  Overall, this may affect a single muscle, a group of muscles, such as those in the arms, neck, and legs, or even the entire body.  Patients with dystonia often have normal intelligence and no associated psychiatric disorders.

The causes of cervical dystonia are currently unknown.  There are two types of cervical dystonia:

Primary cervical dystonia: This type of cervical dystonia is not related
to any identifiable, acquired disorders affecting the brain or spinal cord such
as stroke, infection, tumor, or trauma. In some cases, primary cervical dystonia
is genetic, caused by abnormal genes such as dystonia DYT1. However,
because not all carriers of the DYT1 gene develop cervical dystonia, it
is likely that other genes or environmental factors may play a role in the
development of cervical dystonia.

Secondary cervical dystonia: Unlike primary cervical dystonia, secondary
cervical dystonia has obvious causes such as stroke, tumor, infection in the
brain or spinal cord, traumatic brain injury, toxins, birth defect, etc.  There
may be a period of months between the injury and the onset of the dystonia.

Tests and diagnosis:

The first step when diagnosing cervical dystonia is to determine if any of the causes that may lead to secondary dystonia are evident.  The following tests may be used to screen and/or diagnose for secondary cervical dystonia:

1.Toxins and infections screening: blood or urine samples will confirm the presence of toxins and infections.

2.Tumor screening: an MRI will identify and visualize tumors of the brain or spinal
cord.

3.Genetic testing: can be used to identify DYT1, which is critical to the diagnosis
of primary cervical dystonia.

4.Electromyography (EMG) testing: measures electrical activity of muscles.  An EMG can help diagnose muscle or nerve disorders.

Medications:

Many different medications have been used to treat cervical dystonia but most are not effective:

1.Cogentin and Kemadrin are examples of drugs that decrease the level of acetylcholine. These have helped some patients but have sedating side effects.

2.Valium, Ativan, Klonopin, etc., regulate the neurotransmitter GABA.

3.Sinemet, Laridopa, etc. either increase or decrease dopamine levels.

4.Carbamazepine is an anticonvulsant.

Botox injections:

Botox injections can usually stop the muscle spasms by blocking acetylcholine, relieving the symptoms for approximately three months. Very experienced doctors should administer the Botox injections. If Botox is used for more than a one-year period, it will gradually become less effective because the patient’s body will begin producing auto-antibodies against it.

Other treatments:

In some severe cases, surgery may be an option.  Surgery is the last resort and is used to selectively denervate the nerve supplying the muscle.

Another treatment option is deep brain stimulation.  This involves implanting an electrode in the brain connected to a stimulated device in the chest that generates an electrical pulse.  These electrodes will temporarily disable nerve activities by damaging
small areas of the brain.

Chinese medicine:

According to traditional Chinese medicine, cervical dystonia is caused by excessive liver wind. The liver controls the movement of all tendons, muscles and joints in the human body. Excessive liver wind overstimulates the tendons, muscles and joints, constantly activating the muscles. We use the following methods to treat our cervical dystonia patients.

  1. Acupuncture

The principle acupuncture treatment used to treat cervical dystonia reduces the excessive liver wind and thereby decreases the activities of the tendons, muscles and joints. The acupuncture points are along the meridians of the liver and gall bladder, such as the Feng Chi and Tai Chong points.

In addition, because patients with cervical dystonia have abnormal head and neck movements, acupuncture must also be used along the Du meridian, which controls head movement. The Du meridian supplies the entire brain. If the energy of the Du meridian is excessive, the entire head will move abnormally. Therefore, the acupuncture treatment should also include the Da Zhui and Hou Ding points from the Du meridian.  These points will adjust and regulate the Du meridian, the yang, activate the tendon function, and balance the input and output of the energy of the Du meridian.

The acupuncture treatment should also include the Xin Shu, a direct outlet acupuncture point from the heart and the Shen Shu, a connecting point from the kidney. Sheng MenTai Xi and the points listed above are involved in the circuitry of the heart and kidney, and will decrease the fire surrounding these organs, keeping the yin and yang in harmonious balance. Some local points in the neck and head such as Tian ChuangTian RongTian Ding, and Fu Tu, should also be used for their localized calming functions.

This combination of local and distal acupuncture points will greatly decrease the symptoms associated with cervical dystonia.

  1. Moxibustion:

Moxa is a Chinese herb similar to cigarette to warm certain points in the human body. We suggest to use the following device to moxa the neck sternocleidomastoid muscle for 30 minutes. Patients should learn how to use it before you use for yourself.

  1. Guasha (Scrape) :

Following  the length of  sternocleidomastoid muscle, use the Guasha plate to scrape down 30 times then up 30 times, 5 sessions per day.
The patient was treated with acupuncture at the above points for approximately two months, three times a week. After the last treatment, the number of neck contractions had significantly decreased. Now, she only experiences mild neck jerks and contractions, allowing her to perform her daily activities in a normal manner.

Tips for acupuncturists:

  1. Acupuncture cannot treat all forms of cervical dystonia. The milder the disease, the better the treatment results. Physicians should find the cause if the patient is suffering secondary cervical dystonia.
  2. Using heating pads and massages after the acupuncture treatment increases its effectiveness.

Tips for patients:

1.The earlier the treatment, the better the treatment results.

  1. Help yourself with Guasha, Moxa, massage and heating pad.

 

67. Dr. Jun Xu’s calling from West Africa

Mar 5, 2017   //   by drxuacupuncture   //   Blog, Case Discussions, Uncategorized  //  No Comments

Dr. Jun Xu went to Leprosy village in 2013, 2014 and 2016, soon he will go to the leprosy village on March 31, 2017.

In 2013, there was no a single room being used for treatment in the leprosy village, Dr. Xu and his team had to use a tent. The temperature was around 125 Fahrenheit degrees.

The leprosy patients were waiting for their turn to be attended. Dr. Jun Xu saw about 200 patients a day.

Typical leprosy patient:
Early Stages
Spots of hypopigmented skin- discolored spots which develop on the skin
Anaesthesia(loss of sensation) in hypthese opigmented spots can occur as well as hair loss
“Skin lesions that do not heal within several weeks of and injury are a typical sign of leprosy.” (Sehgal 24)

Progression of disease

“Enlarged peripheral nerves, usually near joints, such as the wrist, elbow and knees.”(Sehgal 24)
Nerves in the body can be affected causing numbess and muscle paralysis
Claw hand- the curling of the fingers and thumb caused by muscle paralysis
Blinking reflex lost due to leprosy’s affect on one’s facial nerves; loss of blinking reflex can eventually lead to dryness, ulceration, and blindness
“Bacilli entering the mucous lining of the nose can lead to internal damage and scarring that, in time, causes the nose to collapse.”(Sehgal 27)
“Muscles get weaker, resulting in signs such as foot drop (the toe drags when the foot is lifted to take a step)”(Sehgal 27)

Long-term Effects
“If left untreated, leprosy can cause deformity, crippling, and blindness. Because the bacteria attack nerve ending, the terminal body parts (hands and feet) lose all sensations and cannot feel heat, touch, or pain, and can be easily injured…. Left unattended, these wounds can then get further infected and cause tissue damage.” (Sehgal 27)
As a result to the tissue damage, “fingers and toes can become shortened, as the cartilage is absorbed into the body…Contrary to popular belief, the disease does not cause body parts to ‘fall off’.” (Sehgal 27)

Every year, Dr. Jun Xu and his team bring around $300,000 worth of medicine donated from his team members and Americares in Stamford, CT to treat the leprosy and other patients in Senegal and Guinea Bissau. http://www.americares.org/, in 2017, his team also received medicine donation from Direct Relief in California, https://www.directrelief.org/.
Dr. Jun Xu and his team finally established a clinic in the leprosy village, one building for the clinic, and another building for the living of doctors and nurses.

Leprosy village people were celebrating the opening of the clinic.

There are 8 wards, which could hospitalize the patients if it is medically necessary.

Dr. Jun Xu’s team usually stay in Senegal for 10 to 14 days, these are the foods his team brought from US in order to keep them health and safe. They do not dare to eat street food.

The above are the coolants contained food Dr. Jun Xu’s team brought from US

Dr. Jun Xu and his team from US in 2006.
If you are interested in joining Dr. Jun Xu’s team or donating to his work in Senegal, please address your check payable to AGWV, and send to
Jun Xu, MD, 1171 E Putnam Avenue, Riverside, CT 06878, USA.
Dr. Xu promises that all your donation 100% will go to Senegal and his team will nerve use a penny from your donation. You will receive the tax deductible receipt. Any amount is a great help for Africa patients.
For more info, please visit our websites at
http://www.drxuacupuncture.co/ and http://www.africacriesout.org/

66. Why did Tiger Woods receive PRP treatment for his knee and ankle pain?

Aug 20, 2016   //   by drxuacupuncture   //   Blog, Case Discussions, Uncategorized  //  No Comments

News Letter, Vol. 7 (3)

August, 2016 © Copyright

Jun Xu, M.D. , Peter  Zheng, M.D.
www.drxuacupuncture.co

Rehabilitation Medicine and Acupuncture Center

1171 East Putnam Avenue, Building 1, 2nd Floor

Greenwich, CT 06878

Tel: (203) 637-7720

Why did Tiger Woods receive PRP treatment for his knee and ankle pain?

Tiger Woods Knee

 

A few years ago Tiger Woods was in the center of media, all his wrong doing such as extra-marital affairs, car crashes, voicemails to girlfriends, etc. attracted many eyeballs. He was also accused of using human growth hormone.  In an interview,  Woods explained that he was actually receiving PRP therapy with excellent result for his knee pain. (http://abcnews.go.com/Health/Technology/tiger-woods-admits-platelet-rich-plasma-therapy/story?id=10303312)

“I had PRP, platelet-rich plasma treatments, and basically, what that is, is they draw blood from your arm, spin it in a centrifuge, and take the plasma out and insert it into the injuries. Well, as you all know, in 2008, I blew out my ACL. And part of my reconstruction of my LCL wasn’t reacting properly. It was a little bit stuck, and so I had the PRP injection into my LCL.

And then, in December, I started to train, started running again, and I tore my Achilles on my right leg. And I then had PRP injections throughout the year…And did everything I possibly could to heal faster so I could get back on the golf course, you know, through the PRP injections.”

Did the PRP help Woods?

So, how did Woods do after the PRP injections in December of 2008?  Actually, Year 2009 was one of the best years of his career. In the 17 events he played in, he made the cut in 16 of them. He won six of the events, finished second in three others, and finished in the top 10 in all but three. He earned over $10 million on the tour alone, and was given the following awards that year:

PGA Tour Player of the Year
PGA Tour Leading Money Winner
Vardon Trophy
Byron Nelson Trophy
FedEx Cup Champion

Many famous athletes — including Tiger Woods, tennis star Rafael Nadal, and several others, such as  Fred Couples, Alex Rodriguez, Tracy McGrady, Chris Canty, Kobe Bryant,  and Cliff Lee, have received PRP for various problems, such as sprained knees and chronic tendon injuries. These types of conditions have typically been treated with medications, acupuncture, physical therapy, or even surgery. Many athletes have credited PRP with their being able to return more quickly to competition.

The American Journal of Sports Medicine, Jun 6, 2016 , published an article “The Effectiveness of Platelet-Rich Plasma in the Treatment of Tendinopathy: A Meta-analysis of Randomized Controlled Clinical Trials.” A total of 18 studies (1066 participants) were included. Eight studies were deemed to be at low risk of bias. The most significant outcomes in the PRP groups were seen in those treated with highly cellular leukocyte-rich PRP (LR-PRP) preparations. The authors concluded ”There is good evidence to support the use of the injection of LR-PRP under ultrasound guidance in tendinopathy. Both the preparation and intratendinous injection technique of PRP appear to be of great clinical significance. “ (http://www.ncbi.nlm.nih.gov/pubmed/27268111)

Even though PRP has received extensive public attention, there are still myths about it, such as:

What exactly is platelet-Rich plasma?
How does it work?
What conditions are being treated with PRP?
Is PRP treatment effective?

What Is Platelet-Rich Plasma (PRP)?

As you know, blood contains mainly liquid (plasma) and small solid components (red cells, white cells, and platelets.) The platelets are best known for their importance in clotting blood. However, platelets also contain hundreds of proteins called growth factors which are very important in the healing of injuries, such as synthesis of collagen, growth of cartilage, production of tendon and fibers, and induction of blood vessels, etc.

PRP is plasma enriched with high concentration of platelets and growth factors — can be 5 to 10 times greater (or richer) than usual by PRP centrifuge procedure.  Then the increased concentration of platelets is injected to the injury sites of human body. The following figures explained how the PRP is made from.

Fig 2

Fig. 2.   https://french.alibaba.com/

How Does PRP Work?

Although it is not exactly clear how PRP works, many researches have shown that the increased concentration of growth factors in PRP can potentially speed up the healing process.

Fig 3

Fig. 3. http://www.nfinders.com/img/product/product_img1_1_1.jpg

To speed healing, PRP is carefully injected into the injured area. For example, in Achilles tendonitis, a condition commonly seen in runners and tennis players, a mixture of PRP and local anesthetic can be injected directly into the heel cord. Afterwards, the pain might be reduced and the injured tissue might quickly heal within one or two months.

What Conditions are treated with PRP? Is It Effective?

Research studies are currently being conducted to evaluate the effectiveness of PRP treatment. Many conditions are treated with PRP, and showed good results.  The following figure indicate the areas of PRP treatment

Fig 4

 

Fig. 4. http://www.absolutehealtheugene.com/files/2014/6808/4960/prp_treatment_of_whole_body.jpg

1. Chronic Tendon Injuries

PRP is most effective in the treatment of chronic tendon injuries, especially tennis elbow, rotator cuff , bicipital tendonitis, wrist tenosynovitis , and iliopsoas tendonitis. The use of PRP for other chronic tendon injuries — such as chronic Achilles tendonitis or inflammation of the patellar tendon at the knee (jumper’s knee)  showed strong evidence that is clinically very effective.

Fig 6

 

Fig. 5. http://www.podiatrytoday.com/files/pt1114ortho3.png

 2.  Arthritis

Research has being done to evaluate the effectiveness of PRP in the treatment of the arthritis. The preliminary data supports PRP is an excellent option to treat different osteoarthritis, such as knee, shoulder, hip and hand.

Knee PRP injection

Fig. 6. http://ihplus.com/wp-content/uploads/2015/11/knee-injection-1024×570.jpg

3. Acute Ligament and Muscle Injuries

Much of the publicity PRP therapy has received has been about the treatment of acute sports injuries, such as ligament and muscle injuries. PRP has been used to treat professional athletes with common sports injuries like pulled hamstring muscles in the thigh and knee sprains. Recently Kobe Bryant went to Germany for PRP treatment. http://grantland.com/features/kobe-bryant-dr-chris-renna-regenokine-knee-treatment/.  All the clinical data indicated it might work on the acute sport s injury.

Sports Injuries

 

Fig. 7. https://www.3bscientific.com/thumblibrary/VR1188UU/VR1188UU_01_3200_3200_Sports-Injuries-Chart.jpg

4. Surgery

More recently, PRP has been used during certain types of surgery to help tissues heal. It was first thought to be beneficial in shoulder surgery to repair torn rotator cuff tendons. However, the results so far show little or no benefit when PRP is used in these types of surgical procedures.

Surgery to repair torn knee ligaments, especially the anterior cruciate ligament (ACL) is another area where PRP has been applied. At this time, there appears to be some  benefit from using PRP in this instance.

5.  Fractures

PRP has been used in a very limited way to speed the healing of broken bones. So far, it has shown no significant benefit.

Conclusion

Treatment with PRP opened a new way to cure your pain. There is much evidence to support this new technology.  For all the acute and chronic tendonitis,  osteoarthritis, and other pain diseases, we are comfortable to treat with PRP. We have already equipped with state of the art instruments to embrace this new wave.  We also received intensive training to perform this new therapy.  You are welcome to give us a call to discuss about the benefits and side effects regarding PRP treatment.

Acupuncture and physical therapy are good therapeutic methods before you try PRP treatment. If you tried all the non-invasive treatments, PRP might be your next option.

The risks associated with PRP are minimal: There may be some pain at the injection site, but the incidence of other problems — infection, tissue damage, nerve injuries — appears to be no different from that associated with cortisone injections.

By the way, please be advised that few insurance plans provide even partial reimbursement.

 

65. Eczema and Acupuncture Treatment

Jul 17, 2016   //   by drxuacupuncture   //   Blog, Case Discussions, Uncategorized  //  No Comments

 

News Letter, Vol. 7 (2)

July, 2016 © Copyright

Jun Xu, M.D. Lic. Acup., Hong Su, C.M.D., Lic. Acup.
www.drxuacupuncture.co

Rehabilitation Medicine and Acupuncture Center

1171 East Putnam Avenue, Building 1, 2nd Floor

Greenwich, CT 06878

Tel: (203) 637-7720

Eczema

Pic 1 Itch

 

http://www.askdrshah.com 

 

 Case History

Jack is a 6 yo boy, who complained itchy and rash for 2 years. The itchy started on his inner elbows gradually spread out along his wrists, behind his knees and ankles.  His itching was slowly getting worse, he went to dermatologist. He was diagnosed of eczema and given topical steroid creams. He used it for about two months, he felt some improvement in the first month, he had no any relief at the second month.

He continued to feel very severe itchy, and cried during night with poor sleep. He had poor appetite and gradually became thin and the rash started to spread to trunk and chest. Jack scratched his skin, which caused skin lesion with some fluid leaking out.  His itch and rash became worse. He came to my office and asked for help.

Types of Eczema

There are multiple types of eczema, including:

1. Atopic dermatitis: this is the most severe and chronic (long-lasting) form of eczema. It’s characterized by itching and inflamed skin that may release a clear fluid when scratched (an effect known as weeping).

Pic 3 Atopic eczema

2. Irritant contact eczema: this is a localized skin reaction to an irritant, and is often caused by acids, cleaning agents, and certain soaps.

Pic 4 contact eczema

3.  Allergic contact eczema (dermatitis): this is a condition in which the skin becomes red, itchy, and weepy after touching a substance that the immune system recognizes as foreign or that you’ve become allergic to, such as poison ivy, nickel, or latex.

Pic 5 allergic contact eczema

 4. Dyshidrotic eczema: this condition is marked by small deep blisters that itch and burn on the hands and feet.

Dyshidrotic Eczema

5. Neurodermatitis (lichen simplex chronicus): this condition is marked by thick, scaly patches of skin on the head, lower legs, wrists, or forearms. It results from frequent rubbing or scratching following a trigger, such as an insect bite.

Pic 6 neurodermotitis

6. Seborrheic dermatitis: this is a chronic condition in which white or yellow scaly patches of skin develop in oily areas, such as the scalp, face, and ears, occasionally other parts of the body

Pic 7 Seborrheic dermatitis

7. Nummular eczema: this condition is marked by coin-shaped spots of irritation that may be crusted, scaly, or itchy, most commonly on the arms, back, buttocks, and lower legs.

Pic 8 Nummular eczema

8. Stasis dermatitis: this condition is marked by skin irritation and inflammation resulting from blood circulation problems.

Pic 9 stasis eczema

 

 

Mechanism of Eczema

Pic 2 Mechnism

 

https://nationaleczema.org/eczema/

 From the above, we understand the key is “itch”. The hereditary and environmental factors cause itch in our body, then we can’t help to scratch, which damages the skin, followed by release of inflammatory chemicals, which causes more severe itch. The above consists of a vicious cycle. Therefore, the eczema becomes worse and worse. 

Causes of eczema

The specific cause of eczema remains unknown, but it is believed to develop due to a combination of hereditary and environmental factors.

Children are more likely to develop eczema if a parent has had it or another atopic disease. If both parents have an atopic disease, the chances increase further.

The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) report that approximately half of children who develop atopic dermatitis go on to develop one of the other atopic diseases.

Environmental factors are also known to bring out the symptoms of eczema. These include:

1. Irritants: soaps, detergents, shampoos, disinfectants, juices from fresh fruits, meats or vegetables

2. Allergens: dust mites, pets, pollens, mold, dandruff

3. Microbes: bacteria such as Staphylococcus aureus, viruses, certain fungi

4. Hot and cold temperatures: hot weather, high and low humidity, perspiration from exercise

5. Foods: dairy products, eggs, nuts and seeds, soy products, wheat

6. Stress: it is not a cause of eczema but can make symptoms worse

7. Hormones: women can experience worsening of eczema symptoms at times when their hormone levels are changing, for example during pregnancy and at certain points in their menstrual cycle.

West Medications

  1. Topical corticosteroids

(sometimes called cortisone) are the standard treatment prescribed for eczema during flare-ups. Applied directly to affected areas of the skin, these ointments, creams, or lotions may:

Reduce inflammation

Tame allergic reactions

Ease irritation or soreness

Reduce itching and the desire to scratch

If topical corticosteroids are ineffective for your eczema, your doctor may prescribe a systemic corticosteroid, which is taken by mouth or injected.

  1. Systemic corticosteroids

Only recommended for short periods of time, since they affect the entire body and can cause a number of serious side effects.

  1. Topical calcineurin inhibitors (TCIs). These prescription drugs include Protopic (tacrolimus) and Elidel (pimecrolimus).

TCIs don’t contain steroids. Instead, they control inflammation and reduce eczema flare-ups by suppressing the immune system.

But TCIs can only be used for short periods of time, and they come with a boxed warning about the possible risk of cancer that is associated with these drugs.

  1. Oral immunosuppressant, such as Neoral, Sandimmune, or Restasis (cyclosporine), Trexall or Rasuvo (methotrexate), or CellCept (mycophenolate).

These drugs carry potentially serious side effects, such as an increased risk of developing dangerous infections and cancers.

If you develop an infection on skin that’s affected by eczema, your doctor will prescribe antibiotic, antiviral, or antifungal drugs to treat it, depending on the particular cause.

  1. Antihistamines for Eczema

Diphenhydramine or doxylamine succinate — to help you sleep through the night. Antihistamines may help prevent nighttime scratching, which can further damage your skin and cause infections.

Various protectant repair creams may also help ease eczema symptoms by restoring essential skin components, like ceramides, fatty acids, and cholesterol.

  1. Light Therapy and Other Treatments

Light therapy or phototherapy — treatment with ultraviolet waves — is often effective for people with mild to moderate atopic dermatitis.

Skin improvements generally don’t happen immediately after phototherapy, but rather after one to two months of treatments several times a week, according to the National Eczema Association.

Burns, increased aging of the skin, and a higher risk of skin cancer are potential side effects of light therapy, particularly if the treatment is given over a long period of time.

Wet-wrap therapy is another option for severe eczema. Sometimes given in a hospital, this treatment involves applying topical medicines (corticosteroids) and moisturizers to affected areas, which are then sealed with a wrap of wet gauze.

Affected areas usually appear very dry, thickened, or scaly. In fair-skinned people, these areas may initially appear reddish and then turn brown. Among darker-skinned people, eczema can affect pigmentation, making the affected area lighter or darker.

Many patients complain of the above treatment are not effective, they are looking for the new methods to help.

Traditional Chinese Medicines

Traditional Chinese Medicine believes the eczema is caused by wet and hot condition, which accumulated in the skin for a long time without exit, therefore the wet and hot stay underneath the skin leading to skin itch.

Avoid hot and spicy food, do not eat pepper, garlic, hot and fried food, and wine, etc., is necessary to prevent the symptom from worsening.

  1. Acupuncture: Acupuncture treatment has achieved some good results; the common points used are Dazhui (Du14), Ganshu (UB18), Feishu (UB13), Shenshu (UB23), Xuehai (SP10), Sanyinjiao(SP6), and Zusanli (St 36). The main purpose is to expel the wet and hot out of the skin and internal organs.

  1. Cupping: Cupping the above points usually patients will feel quick relief of the symptom.

  1. Chinese Herbs: 

1). Take by mouth: 

Three types of Traditional Chinese Medicine treatment:

  1. Floating of Wet and Heat: fresh hot rash, severe itching, liquid floating out, accompanied with slightly fever, dry mouth, constipation, yellowish and shot urine, dry tongue with white or yellowish coating. The Chinese herb formula is Longdan Xiegan Tang.

  2. Wet Stasis with deficiency of spleen: dark and red skin, itching, slightly liquid outing, accompanied with bloating, loose diarrhea, big tongue, white and thick coating. The Chinese herb formula is Chushi Weiling Tang.

  3. Deficiency of blood and dryness with wind. Long period of itching, dark and thick skin, accompanied with thirsty, light tongue. The Chinese herb formula is Danggui Yingzi.

2), Topical Cream: Chinese herb formula, Sanhuangxiexin Tang.

The treatment course for Jack: 

The patient underwent about 12 sessions of acupuncture treatment; he also received cupping at his certain points and Chinese herb cream. After first two sessions of treatment, he felt less itching, and he slept much better. He then had much less itch and almost no fluid came out of his skin lesion. He gradually gained full sleep, and finally his itching and skin lesions were gone and his eczema was much improved. He was told to stop eating the hot and spicy food.

Tips for Acupuncturists:

The most important points are Dazhui (Du14), Ganshu (UB18),  Feishu (UB13), Shenshu (UB23), Xuehai (SP10), Sanyinjiao(SP6), and Zusanli (St 36). You may add a few points depending on the patient’s needs, for example, if patient feels stress and poor sleep, you may add Shenmen (HT7), Baihui (DU20), Fengchi(GB20) Fengfu(DU16).

Tips for patients:

 Please do not eat hot and spicy food, such as hot pepper, fried food, Garlic, etc.

 

 

64. Acupuncture and Infertility Case Discussion

Jan 23, 2016   //   by drxuacupuncture   //   Blog, Case Discussions, Uncategorized  //  No Comments

 

News Letter, Vol. 7 (1),  January, 2016 © Copyright

Case Discussion

Acupuncture and  Infertility

Jun Xu, M.D. Lic. Acup., Hong Su, C.M.D., Lic. Acup.
www.drxuacupuncture.co

Rehabilitation Medicine and Acupuncture Center

1171 East Putnam Avenue, Building 1, 2nd Floor

Greenwich, CT 06878

Tel: (203) 637-7720


Baby

Amy S., a 36-year-old woman, is an OB-GYN at a Connecticut hospital, who delivers babies every day. When she finished her residency two years ago, she and her husband wanted to have a baby and tried for a pregnancy for a year to no avail. As a doctor, Amy is well aware of the workings of her body. She consulted the best endocrinologist and infertility specialist in the area, who checked her hormone levels, including the thyroid, pituitary gland, adrenal gland, ovaries, etc., only to find nothing was wrong. She was careful about nutrition, was at her ideal weight of 120 pounds and neither drank nor smoked. She also had an ultrasound study which showed no problem in her tubes, uterus or ovaries. Amy’s husband was also examined and shown to have a normal quantity and quality of sperm with no antisperm antibodies; the delivery of his sperm was also normal. He showed no retrograde ejaculation and no blockage in the ejaculatory duct.
Amy came to me for consultation and evaluation. She is an open-minded physician, devoted to her job, and works between 55 and 60 hours a week. Her husband is an emergency physician who works in the same hospital and he, too, works hard. Amy and her husband are often on call, causing much stress. They both keep irregular hours and often do not see much of each other. From her history, I could tell she was very stressed, unhelpful to her pregnancy situation.
Amy told me she had read an article which indicated that acupuncture plus IVF (in vitro fertilization) could help the patient increase the success rate for pregnancy. She tried it once without success.
Based on the above information, Amy has unexplained infertility. Unexplained infertility is, by definition, when a couple has not conceived after 12 months of contraceptive free intercourse.

 

In order to understand Amy’s condition, let’s discuss some basic physiology of women.

 

BBT

·       Basal Body Temperature (BBT) is women’s body temperature at rest (wake up time).

·       BBT rises after ovulation due to increased progesterone released from the corpus luteum after ovulation.

·       Ovulation can be detected on a fertility chart for the day BEFORE the temperature rises.

·       When ovulation is detected on a fertility chart, the chart shows a biphasic (lower temperatures followed by higher temperatures) pattern.

·       BBT stays in the higher range throughout the luteal (post-ovulation) phase until the next cycle begins.

·       BBT stays high if there is a pregnancy.

 

What is this BBT chart about?

·       Follicular phase

The follicular phase begins on Day 1 of the menstrual cycle. Estrogen and progesterone levels are at their lowest during menstruation. During this phase the uterine lining, or endometrial lining, both sheds through menstruation and begins a period of regrowth and thickening in preparation for an embryo should conception occur.

 

The follicular phase lasts about 10 to 14 days, or until ovulation occurs.

 

Before a woman ovulates, the basal body temperatures range from around 97.0 to 97.5 degrees Fahrenheit (36.1 to 36.3 Celcius). This is due to the presence of estrogen, which keeps temps down. Temperatures will vary from person to person, but should stay below your cover line.

  Luteal phase

The luteal phase begins when ovulation occurs. During ovulation, the ovaries release a single egg from only one of the two ovaries during each menstrual cycle. Ovulation is a process that begins when the level of luteinizing hormone or LH surges, and ends 16 to 32 hours later with the release of an egg from the ovary.

 

Once ovulation has occurred, the temps go up from around 97.6 to 98.9 F (36.4 to 36.6 C). The day after ovulation, the temp generally jumps up by at least 0.2 degrees F (0.11 degrees C), and then continues to rise somewhat. This increase in temperature is caused by the progesterone released from the follicle after ovulation.

The actual temperatures are less important than noting a pattern showing two levels of temperatures. If there is no pregnancy, then this temperature will stay elevated for 10 – 16 days, until the corpus luteum regresses. At this time, progesterone levels drop dramatically and you get your period.

If your Basal Body Temperature remains elevated for 18 days or more after ovulation, you should probably test for pregnancy.

BBT

 

Ovulation

·       After ovulation, the corpus luteum produces the heat-inducing hormone, progesterone to prepare the lining of the uterus for the implantation of a fertilized ovum. Progesterone causes the resting body temperature to rise after ovulation so that it is possible to identify ovulation for the day BEFORE the temperature rises.

 

·       A fertility chart that shows ovulation detected by BBT will have a BIPHASIC pattern. This means that it will show lower temperatures before ovulation, a rise (thermal shift), and then higher temperatures after ovulation. Ovulation usually occurs on the last day of lower temperatures. Then higher temperatures after ovulation.

 

·       To illustrate, see the image below. The blue dots represent daily temperature readings. Ovulation is identified by the vertical red line. The horizontal red line is a “cover line” to help to visualize the biphasic pattern.

BBT2

 

Conception takes time

·       A normal, healthy couple only has a 25 percent chance of conceiving each month, even when they have sex right around the time of ovulation. After a year of trying, 75 to 85 percent of couples will have conceived.

·       If your Basal Body Temperature remains elevated for 18 days or more after ovulation, you should probably test for pregnancy.

6 Pregnancy Tips

1.  Have Intercourse Often: Sperm can survive in a woman’s body for up to 5 days. To increase your odds, you should have sex frequently 3 days before ovulation and continuing for 2 to 3 days after you think you’ve ovulated.

2.  Lie Low after Sex: Sperm has to swim upstream to meet your eggs, stay in bed for at least a few minutes after intercourse.

3.  Create a Sperm-Friendly Environment: Avoid putting any chemicals into your vagina, such as vaginal sprays, scented tampons, artificial lubricants, and douching. They can alter the normal acidity of the vagina.

4.  Know When You Ovulate: Please use the above chart to estimate your ovulation day. You might also use an over-the-counter ovulation predictor kit (OPK) to check for hormonal changes in your urine before ovulation.

5. De-Stress: Try acupuncture, yoga, meditation, or long walks to reduce stress. Research indicates that stress can interfere with getting pregnant.

6.  Maintain a Healthy Weight: Studies show that weighing too little — or weighing too much — can disrupt ovulation and may also affect production of key reproductive hormones. A healthy BMI is between 18.5 and 24.9.

healthy-bmi-chart

Definition of Infertility:

a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse.(WHO).

There are many causes of infertility, including the following:

For the male:

1. Impaired production and function of sperm, low sperm concentration. Normal sperm concentration is greater than or equal to 20 million sperm per milliliter of semen. A count of 10 million or fewer sperm per milliliter of semen indicates low sperm concentration, and the chances of conception lessen. A count of 40 million sperm or higher per milliliter of semen indicates increased fertility; also, if a sperm changes its shape and mobility or is slow, the sperm may not be able to reach or penetrate the egg.

2. The malfunction of the Hypothalamic-Pituitary-Gonadal Axis: if the axis is not working properly, the male hormone level will be disturbed and the sperm will be both low in count and slow in activity.

3. The testes system, including transportation and maturation.

For the female:

1. Fallopian tube damage or blockage.

2. Endometriosis.

3. Ovulation disorders.

4. Hormonal causes, such as hypothyroidism,

4. Early menopause.

5. Polycystic ovary syndrome.

6. Fibroid in the uterine.
Even though there are many women who cannot conceive because of the above reasons, there are also 15-20 % of couples who cannot conceive due to unexplained reasons, and Amy falls into this category. Therefore, many couples have to use the following technology for help.

Assistant Reproductive Technology:

1.     Intrauterine Insemination (IUI)

Intrauterine insemination is the placement of a man’s sperm into a woman’s uterus using a long, narrow tube, which usually help the sperm to go upstream to meet eggs. The successful rate sometimes can be 20%.

2.     In Vitro Fertilization (IVF)

Eggs and sperm are taken from the couple and are incubated together in a dish in a laboratory to produce an embryo. The embryo then will be placed into the woman’s uterus, where it may implant and result in a successful pregnancy.

A. IVF stimulation protocols in the US generally involve the use of 3 types of drugs:

1), Medications to suppress the luteinizing hormone (LH) surge and ovulation until the developing eggs are ready.

There are 2 classes of drug used for this:

GnRH-agonist (gonadotropin releasing hormone agonist) such as Lupron,

GnRH-antagonist such as Ganirelix or Cetrotide

Lupron essentially “shuts down” the body’s reproductive hormone system.

While shut down, IVF patients use a follicle stimulating hormone (FSH) drug like Gonal-F or Follistim, to cause the recruitment and development of follicles. Dosages of FSH are adjusted based upon each patient’s response and it is continued until the follicles are mature.

2), FSH product (follicle stimulating hormone) to stimulate development of multiple eggs

Gonal-F, Follistim, Bravelle, Menopur

3), HCG (human chorionic gonadotropin) to cause final maturation of the eggs

The ovaries are stimulated with the injectable FSH medications for about 7-12 days until multiple mature size follicles have developed.

Ovulation cannot occur naturally while on Lupron because LH, which triggers ovulation, is suppressed. This prevents a premature surge of the LH before the retrieval, which could cause loss of the cycle. Once the eggs are mature, an injection of Human chorionic gonadotropin (hCG) or LH is given to stimulate ovulation. Egg retrieval is scheduled 35 hours later.

 B. Egg Retrieval:

this is the process used to remove the eggs from the ovaries   so they can be fertilized.

C. Fertilization:

the sperms are placed in a dish with the egg and left overnight in an incubator. Fertilization usually occurs on its own. However, sometimes, a single sperm is injected into an egg using a needle. This process is called intracytoplasmic  sperm injection (ICSI). About 60% of IVF in the Unites States is performed with ICSI.Embryos that develop from IVF are placed into the uterus from 1 to 6 days after retrieval.

 D. Embryo Transfer:

a long, thin tube will be inserted through the vagina and into the uterus and injects the embryo into the uterus. The embryo should implant into the lining of the uterus 6 to 10 days after retrieval.

Evidence of Acupuncture as an adjunct to IVF

Now, more and more evidence show acupuncture as an excellent adjunct to IVF. In one article published in Evidence Based Complement Alternative Medicine, 2012, Zheng, et al found out that Twenty-three trials ( a total of 5598 participants)  indicate that acupuncture, especially around the time of the controlled ovarian hyperstimulation, improves pregnancy outcomes in women undergoing IVF.

(Evid Based Complement Alternat Med. 2012;2012:543924. doi: 10.1155/2012/543924. Epub 2012 Jul 2.

The role of acupuncture in assisted reproductive technology.

Zheng CH1, Zhang MM, Huang GY, Wang W.)

 

Another study also showed significant improvement of odds with acupuncture treatment.

Reprod Biomed Online. 2015 Jun;30(6):602-12. doi: 10.1016/j.rbmo.2015.02.005. Epub 2015 Feb 24.

Impact of whole systems traditional Chinese medicine on in-vitro fertilization outcomes.

Hullender Rubin LE1, Opsahl MS2, Wiemer KE2, Mist SD3, Caughey AB3.

 

The following acupuncture protocols are used to help IVF patients:

 

A.    Lupron Routine:

to help suppress the luteinizing hormone (LH), and reduce the side effects of Lupron, Ganirelix or Cetrotide

 

1.     Diji (SP8), Zhongji (Ren 3), Xuehai (SP6), Zusanli (St 36), Sanyinjiao (SP6), Hegu (LI4), Taicong (Lv3).

2.     Cerebrum acupoints(HP-Zone)

Yameng(DU15), Fengfu(DU16),Naohu(DU17)

Tianzhu(UB10),Fengchi(GB20),Wangu(GB12)

3.     Huatuojiaji:

 

B.    FSH Routine:

to help stimulation of multiple eggs.

1.     Cerebrum acupoints(HP-Zone)

Yameng(DU15), Fengfu(DU16),Naohu(DU17)

Tianzhu(UB10),Fengchi(GB20),Wangu(GB12)

2.     Intersection-Zone:

Baihui(Du20),Sishencong(EX-HN-1),Touwei(St8)

3.     Abdominal Zone:

Guanyuan (Ren 4),Zigong (EX Points)

4.     Sacrum-Zone:

Mingmen (DU4),Shenshu (UB23), Eight Liao Points (UB31-UB34).

C.    HCG Routine:

to improve the final maturation of the eggs

1.     One day before egg retrieval: Neiguan (PC6) , Zusanli(St36), Pishu (UB20), Shenshu (UB23), Ganshu(UB18) , Diji (SP8), Taixi (Kid3), Taicong (Liv 3), Quchi (LI11).

2.     Three hours before egg retrieval: Zigong (Extra Points), Sanyinjiao (SP6), Hegu(LI 4), Neiguan(PC6), Taicong(Liv 3), Quchi(LI11).

D.    After Egg Retrieval:

Many patients showed the following symptoms, such as abdominal tender, emotional unsteady, headache, weight gain, nausea and sometimes vomiting, etc.

On the same day: Qihai (Ren 6), Shuidao (St 28), Daimai(GB26), Yinlingquan(Sp9), Sanyinjiao(SP6), Zusanli(St36), Xiaguan (St7), Quchi(LI11), Taicong(Liv3).

E.    For the mobility and viability of Sperm:

Zhongji(Ren3), Guanyuan(Ren4), Zusanli(St36), Taixi(Kid3), Shenshu(UB23), Mingmen(Du 4), Dahe(Kid12), Sanyinjiao(SP6).

F.    Before the Embryo Transfer:

For continues three days: Qihai(Ren6), Guanyuan(Ren7), Sanyinjiao(SP6), Zusanli(St36), Taixi(Kid3), Xuehai(Sp10), Pishu(UB20), Shenshu(UB23), and Ganshu(UB18).

G.   After the Embryo Transfer:

Within 24 hours: Quchi(LI11), Neiguan(PC6), Sanyinjiao(SP6), Zusanli(St36), Taicong(Liv3).

Within 36 hours: Quchi(LI11), Zusanli(St36), Xuehai(Sp10), Diji(Sp8), Taixi(Kid3), Taicong(Liv3), Ear Shenmen, Ear Neifenmi, Ear Zigong.

H.    After confirmed pregnancy:

Quchi(LI11), Zusanli(St36), Neiguan(PC6), Yinlingquan(Sp9), Taixi(Kid3), Taicong(Liv3), Ear Shenmen, Ear Neifenmi, Ear Stomach, until six weeks of pregnancy.

Some important acupuncture points:

Back PointsAbdomen

Amy’s treatment:

Amy was scheduled to have hormone regulation (hormone treatment) for a month before trying to become pregnant again, and to have acupuncture treatments with me three times a week during that month.

 

After four weeks of treatment, Amy underwent the IVF procedure and was kept on the acupuncture treatment twice a week. Amy reported to me that she had eight eggs mature, a much improvement compared with  the first IVF treatment which had produced only three mature eggs.
After a 48 to 72 hour culture, six of her eggs were fertilized and Amy’s doctor implanted four into the uterus. The doctor told her she should have bed rest overnight and that she could return to work the next day; however, I told her to have bed rest for two days, because Amy’s job is more stressful than most people’s, and she has to bend forward in her work to deliver babies.
A month after insemination Amy told me she was pregnant. She was very excited about her condition and eight months later delivered twins, a boy and a girl. She was thrilled with the results, as was her husband.

My personal experience:

1. In unexplained infertility, most of the cases are stress related. As an OB-GYN doctor, Amy worked very hard, as did her husband, and they had little time to be together. They are both under constant stress, their bodies always tight, in particular Amy’s uterus muscles. These factors made it very difficult for the fertilized eggs to attach themselves to the uterus. Some patients may be lucky enough to be pregnant; however, they may not retain their baby in the uterus because of the stress and tightness of their uteruses. They may have frequent miscarriages. My treatment is mainly for stress-reduction.

2.  Many unexplained infertility patients have irregular hormone environments in their bodies because of their high stress levels. These will affect the patient’s entire reproductive system, such as Oocyte maturation, delivery, fertilization, implantation, etc. My acupuncture points are selected to adjust the hormone environment and make the different hormones harmony.

3.  Each patient should have about one month of acupuncture treatment before starting the IVF procedure to prepare the patient’s hormonal system and to have her relax psychologically.

4.  It is extremely important for the patient to have 48 hours of bed rest after insemination before taking up normal activities, because at this time the fertilized eggs are very weakly bound to the uterus. Any inappropriate movement during these first 48 hours might cause an early miscarriage.

5.  For the key acupuncture points, you may do the acupressure by yourself as indicated above.

I thank Dr. Ming Jin, a professor from Shanghai University of Traditional Chinese Medicine, who gave me a lot of important input.

63. Dr Jun Xu was featured on Greenwich Time on August 26, 2015

Aug 28, 2015   //   by drxuacupuncture   //   Blog, Case Discussions, Uncategorized  //  No Comments

Dear Friends:

I have been featured on Greenwich Time on August 26, 2015. Please click the following link to read the entire article.

http://www.greenwichtime.com/news/article/Acupunture-joins-options-of-couples-hoping-to-6465359.php#photo-8533281

Acupuncture treatment for infertility is a popular adjunct treatment with IVF.  I have been working with Greenwich Fertility Center and helped many patients.

If you have any friends or relatives, who are interested in my service, please forward this news letter to them.

Thank you very much!

Best,

 

Jun Xu, MD

Rehabilitation Medicine and Acupuncture Center

1171 E Putnam Avenue, Riverside, CT 06878

Tel:203-637-7720

61. My Medical Trip to West Africa in April, 2014

Nov 16, 2014   //   by drxuacupuncture   //   Blog, Case Discussions, Uncategorized  //  No Comments

My Medical Trip to West Africa in April, 2014

Jun Xu, MD

 

1.     Before the trip

On April 19, 2014, I landed in the dry heat of Senegal Airport. After one year away, I feltlike I had returned to the land of my soul.

I had gone to West Africa last year for my first medical mission. It had been difficult to face the patients, and especially the children. My heart sank to hear to them talk about their dreams to go to build a better life and to go to school.

I always believed that it is important to teach a man to fish, not just give him a fish. After I returned to the US, Paston Nilson and I decided to build a trade school in Africa. There are many plumbers, electricians and carpentries in Pastor Nilson’s church. We realized that we would have enough teachers for this school. We expected the students could return something to the school after they learn these skills and eventually the school could be self-sufficient.

A fundraising party became the most important issue in my mind. We needed 400 guests in the hopes of collecting about $40,000 contribution. I sent emails to my patients, more than 5,000 in total. Yet, I only sold 40 tickets. I was beside myself.

But on the day of fundraising party in Christ Church, waves of people came in. We pulled out all the tables in storage in the Parish Hall after we realized so many people were coming in. We could hardly hold all the people. 250 people came, and we filled to maximum capacity. My guests enjoyed the food and Chinese acrobatics, and we received just a little more than $40,000 donation. I had achieved my goal!

2. Ebola Virus

Ebola virus suddenly out broke in Guinea and other West Africa countries in February 2014. Based on a recent study, the virus gets in the human body by consuming semi-cooked bat meat. The virus quickly duplicates in the human body and destroys the endothelium cells of capillary vessels. The main symptom is high fever, bleeding everywhere inside the body. Ebola has a more than 50% death rate. In August 28, 2014 Science published an article about the virus’s DNA sequence, where five of the authors had sacrificed their lives to collect the samples from 78 patients. Ebola is transmitted mainly through body fluid, and no evidence has shown the virus can spread through airborne contact. There is no effective treatment for the virus, and no vaccine could prevent this illness.

Before I left for Guinea Bissau, there were more than 100 patients diagnosed with Ebola and more than 70 patients who had died in Guinea. Guinea and Guinea Bissau used to be one country and were separated in 1974. People were able to cross the border freely; therefore, there was a high chance to spread out the virus from Guinea to Guinea Bissau.

My wife and friends tried to persuade us to cancel the trip. Pastor Nilson’s church also was very concerned about the safety of our 15 team members. The Senegal Embassy rejected the visa of 6 out of 15 team members until the last day before our trip. However, we were determined to go. Even if there was Ebola in Guinea Bissau and Senegal, we might be able to help the patients there.

When we arrived in Dakar, the capital city of Senegal, we realized there wasn’t any special tension in Dakar. People were very relaxed and did not seem to be paying much attention to the danger of Ebola. I stayed one night in Senegal and finally arrived Guinea Bissau. The temperature was 105 F. Two of our members were sick and sweating. The hot, dry atmosphere attacked us from everywhere. There was no air-conditioning, no fresh food, and we felt the waves of heat penetrate each cell of our bodies all the way into our brains. It just felt so hot! We left two members at the base, and we were ready to see patients.

3.     Meeting the patients I attended last year.

The patients were waiting for us

My heart was pounding when our bus was roaring on the twisted small road.  The bus incurred tremendous dust surround us. The vivid images were still fresh in my mind. I used to sweat and cry in this jungle village. Many tree branches blocked the road, to the point that we had to stop to cut the branches to make our bus move forward.

A patient sat in the shadow of a big tree, a walker next to him. His left ankle had been amputated

He was amputated of his left ankle because the  diabetes before I saw him, his wound was slightly infected, but under control. My son, Jimmy, a medical student at the University of Wisconsin-Madison Medical School, cleaned out his wound and I gave him antibiotics and anti-diabetes drugs like last year. However, he looked at me without any sign of excitement. It seemed he did not know me. I guessed that his vision must be damaged by diabetes.
Crowded patients came in, many whose faces were so familiar.
“ Hi, I know you, I gave you antibiotics for high fever!” The patient shook his head with apathetic expression.

“Hi, I remember you.” I said to another patient.

“ No, I never saw you before”, a determined answer shocked me.

“That’s not true…you only brought four of your children to me this time!” I said straightforwardly.

She had brought 6 children to me in last year. I had felt so sad when she looked at me with despair and helpless. I gave her antibiotics and multivitamins and took pictures of her family. I had very often spoken to my friends about her after I returned to US. She silently nodded her head and admitted she had seen me before.

This mother has six children

I love taking photography, especially portraits. I edited many pictures I took in West Africa last year. The unique characters of my patients made them unforgettable. I always think about them during my dreams. 100 patients passed by, only two patients smiled at me and told me they were happy to see me there. Most patients were indifferent. Poverty, ignorance and superstition prevail in this jungle village.

Under the hot 115F weather, we attended about 250 patients a day. One day we saw 450 people, and we were exhausted that we did not even have the energy to get on the bus. However, we cannot change their fate with the challenge of poor hygiene, lack of water and roads, no education, which are beyond our capability.

Crowded Patients were waiting for us

Tchaikovsky’s Pathétique flowed in my heart. The cello’s weeping was like a small knife cutting my soul. The melody sounded like spring, stretching the strings of sympathy deep in my heart. No hope, there was no any hope, I desperately thought, as my mind went with Tchaikovsky to beg God for help!

4.     Ebola or Malaria?

The second from the left is Salsa

Salsa is one of my team members who went to West Africa for the last 5 years. Salsa went earlier to Guinea Bissau than I did this time. When I arrived there, he immediately reported to me that he had a sudden onset of fever and chills with swelling below both knees. He felt a burning sensation and fatigue in entire body. When I examined him, both his knees were swollen and red. He lay on the bed like a poor lamb with his eyes tearing. Although I was worried that he might have Ebola, I decided his symptoms were not severe enough and gave him quinine to treat him for malaria and told him to drink a lot of water.

On the second day, our team had gone to another village. When we returned to the base, Salsa was gone. He had come back to US and went directly to the ER. Thank God, he was confirmed for malaria.

Looking at his empty bed, I recalled his stories. Two years ago, he had hired two African workers to install the brick wall at the base with his own money. He saw his worker, Qunta, drinking some yellowish soup, with some thick stuff floating in it. He tried to taste the soup, and he immediately vomited. Qunta told him it was made from cardboard. Salsa began to cry and he asked Qunta to lead him his home.  Eight people, Quanta, his wife, and 6 children, lived together in one small room. His wife was cooking the cardboard soup in a pot on three stones outside the room. Qunta told Salsa he only had a job two weeks per month. Making $8 per day, he could only support his family with minimum food and shelter. Salsa had never thought there was such a poor family like Qunta’s, He did not say a word as he left the house.

Salsa returned with 2 kg of beef, two chickens, eggs, and vegetables. Quanta’s family had never enjoyed food like they did that night. They slept with full stomach, every cells in their body were very happy to soak the nutrition they lacked for long time.

The next day, Salsa gave Quanta a key. Salsa had bought a house in Senegal with $8,000, and he would let Quanta live there for free.

5.     Heroes in Africa

 

When someone asked Newton about his success, he replied, “if I have seen further it is by standing on the shoulders of giants.” Many of my friends admired me for going to West Africa. However, I only dare to say, I am lucky to stand behind many giants like Pastors Ottavia, Carlos, Nilson, Luciana, and the rest of our team.

From the left: Melisa, Pastors Luciana, Nilson and Ottavia

We all know mother Teresa, however, not many people know Pastor Ottavia. He was a soccer player on the Brazilian national team before he went to Guinea Bissau 39 years ago with his wife. He was the second person in the country to establish a church and school. However, in the1970s, the communist party took over the country and Pastor Ottavia and his wife were deported. After the communist party stepped down, they returned Guinea Bissau and worked hard again. Now they support about 40 African pastors, 15 churches, and 3 elementary schools with 450 students. Pastor Ottavia’s two children were born in Africa without a good education until one day a missionary pastor from California they brought them to the US to attend high school. The Ottavias have no any personal property—they still live in one small room in the missionary base.

Pastor Carlos, a college football player in US, received his green card after graduation. However, he decided instead to go to Africa with his young wife and daughter. As we talked about his permanent residency in US, his eyes blinked toward me like a deep, clean lake without any wave. He is willing to give up the best in his life to serve the poor people in Africa.

Pastor Nilson, a pastor with a few churches in Port Chester, NY  and Bridgeport, CT, went to Africa 13 years ago, his soul was attracted by the bright-colored sun in Africa. 2014 is his 13th trip to Africa, every year, he brings about $100,000 worth food, vegetable oil and other supplies. His church also supports the elementary schools and local churches. He brought his son Andrea with him, he said he may not be able to go to Africa someday, his son would take over this job.

Pastor Luciana, a retired colonel from the Brazilian army, went to Africa with his wife, Melisa, and their one-year-old daughter eight years ago. He is building a missionary base with 50,000 SF His wife is in charge of 3 elementary schools with 450 students.  His daughter attends a private school in Guinea Bissau. They live in a house with a deep narrow road. There is no city drainage system. In the rain season, all the garbage is washed to the road, and in the sun, flies and mosquitoes occupy every space in the air within the unbearable smell They cannot open their door.  I cannot believe that I would bring my family to live in this environment. I definitely would not allow my daughter to grow up in that condition. It takes a special kind of sacrifice.

6.     Future Plan

On my last day in Africa, I was called to the base office. Two local contractors were waiting for us to sign the contract. We are planning to build up a trade school where we would like to teach local students with the skills of electrician, carpentry, plumber and painter, etc. This is a 20,000 square foot building with a budget of $100,000. My friends and patients have contributed $60,000, I told Pastor Ottavia that I still own him $40,000.

                                            We signed the contract, the land behind us will be the future trade school

I also have another dream to build up a hospital in the leprosy village in Senegal. I went to the leprosy village and stayed in the village with my team members and son, Jimmy, for two days in last year. Many patients were amputated because of lack medical care. I would really like to help them if I could raise enough funds.

My dear friends, I can honestly tell you that all your contribution will go to Africa people 100%. All my team members paid for their own airfare, food, room and board. I also self-funded for the medicine I brought to Africa. Let’s work together for the future of Africa people.

If you would like to support our plan, please write your check address to

AGWV (Assembly of God World Vision)

Mailing address: Jun Xu, MD, 1171 E Putnam Avenue, Riverside, CT 06878, USA

Email: iloverehabmed@hotmail.com

You will receive a tax deductible receipt.

59. Frozen Shoulder and Acupuncture Treatment

Oct 23, 2014   //   by drxuacupuncture   //   Blog, Case Discussions, Uncategorized  //  No Comments

News Letter, October, 2014, © Copyright

 

Jun Xu, M.D. Lic. Acup., Hong Su, C.M.D., Lic. Acup.

James Olayos, DPT, CSCS

www.rmac.yourmd.com; www.drxuacupuncture.co

Rehabilitation Medicine and Acupuncture Center

1171 East Putnam Avenue, Building 1, 2nd Floor

Greenwich, CT 06878

Tel: (203) 637-7720

 

Frozen Shoulder and Acupuncture Treatment

 From: www.1thing.info/50kata/gojukata1.gif   

 

Martha T. is a 50-year-old woman with a long history of diabetes.  Approximately two months before consulting me, she felt a slight pain in her right shoulder when she tried to lift a heavy object.  Though the pain was not severe for the first few weeks, she gradually noticed a decrease in the mobility and function of that shoulder, coupled with more severe pain.  After the incident, she had trouble lifting her arms for tasks such as combing her hair and dressing with ease, especially when putting clothes on her right arm or fastening her brassiere.  Hoping the pain would go away, she did not consult a doctor.

When the pain became too severe, she came to me.  By physical examination, I noted that there was moderate tenderness at the right frontal and posterior shoulder.  Through palpation, I noted tenderness in her upper arm and lateral elbow.  She had difficulty raising her right shoulder up to her head and with movements that crossed the body’s middle line.  The pain was constant and she was unable to sleep on the right side of her body. Her right arm was weak due to the pain. There was no numbness or a tingling sensation.

 

Martha suffers from a “frozen shoulder,” or, in medical terminology, adhesive capsulitis.

Fig. 1

 

 

This usually occurs after the age of 40, and about 20% of patients who suffer from this disorder have a history of diabetes and most of them have also been involved in some form of accident.  When these patients begin to feel shoulder pain, they try to compensate by limiting the normal range of motion in the injured shoulder.  Unfortunately, this makes some normal tasks such as brushing the hair, dressing, reaching for objects above the head, etc., more difficult.  By this stage, the patient usually realizes it is necessary to seek medical treatment for the condition.

Frozen shoulder is usually exhibited in three stages:

  1. Painful stage: A gradual onset associated with a vague pain. Unknown specific date of onset.  Lasts roughly 8 months.
  2. Frozen stage: The pain may begin to diminish during this stage. However, the shoulder becomes stiffer and the range of motion decreases noticeably, which causes the patient to avoid extreme movements that exacerbate the pain during this phase.  Usually lasts from six weeks to nine months.
  3. Thawing stage: The shoulder movement gradually returns to normal and the pain lessens.  Lasts from five months to two years.

 

Though the causes of frozen shoulder are still unclear, these are some noted possibilities:

  1. Injury resulting from surgery or any traumatic accident.  Most patients have a history of an injury that causes pain and causes the patient to decrease his/her range of movements.
  2. Diabetic patients have a tendency to have frozen shoulder. In those patients who are diabetic (about 20%), this condition worsens the symptoms.
  3. Autoimmune, inflammatory, and any procedures that immobilize the shoulder will increase the chances of frozen shoulder.

 

Western medicine treatments:

  1. Anti-inflammatory medications: The use of anti-inflammatory medications such as ibuprofen, naproxen, etc. However, these oral medications are not a very effective treatment.
  2. Corticosteroid injection: Using a corticosteroid (i.e. 40 mg of Kenalog and 5 cc of 1% lidocaine injected directly into the shoulder bursa) will greatly decrease the intensity of the pain. However, there are some side effects of corticosteroid injections such as blood sugar elevation, fragile shoulder tendons, osteoporosis, etc. I usually do not recommend using corticosteroid injections unless it is absolutely necessary (i.e. when there is severe pain, largely decreased range of motion, and handicapped daily activities).
  3. Physical therapy: Using heating pads, stretching, performing wheel range of motion exercises, muscle strengthening, electrical stimulation, ultrasound, electrophoresis, etc.  The dual treatment of corticosteroid injection and physical therapy can be very effective.

 

In some cases, surgery may be necessary.  There are two common types of surgery used to treat frozen shoulder:

  1. Manipulation under general anesthesia: forces the shoulder to move.  This process can unfortunately cause the capsule to stretch or tear.
  2. Shoulder arthroscopy: The doctor makes several small incisions around the shoulder capsule.  A minute camera and instrument are inserted through the incision and the instrument is used to cut through the tight portion of the joint capsule.  Often, manipulation and arthroscopic surgeries are used together and many patients have good results form this type surgery.

Physical Therapy Treatment for Frozen Shoulder:

 

Physical Therapy treatment generally begins in the first stage of the “frozen shoulder” progression. Upon initial PT evaluation of the effected shoulder, the therapist will begin with gentle passive and active range of motion activities within the patient’s pain tolerance. The primary goal in stages 1 and 2 of the frozen shoulder progression is to reduce pain and begin to regain normal joint motion. Passive stretching of the shoulder in all planes and manual joint mobilization techniques are indicated. Pain relieving modalities such as heat, electric stimulation, and short-wave diathermy can be used when it is at the therapist’s disposal. In addition, basic postural re-education exercises such as scapular retraction and pectoral stretching should be introduced.

Fig. 2

 

Fig. 3

 

 

Fig. 4

 

 

As the patient progresses from the “freezing” stage of the condition, more aggressive joint mobilization and stretching techniques are introduced to regain full motion of the shoulder joint. This stage can be painful at times, but it is necessary for long term results and return of normal function. Therapeutic exercises (shoulder elevation, rotation, scapular retraction against resistance, etc.) are progressed to allow for shoulder stabilization within the new ranges of motion achieved with stretching and joint mobilization.

During the final stage of the frozen shoulder progression, the therapist will introduce functional activities to ensure that the effected shoulder is prepared for daily tasks. Pain level should be decreased at this point in treatment.

 

 

Traditional Chinese Medicine Treatment:

 

The following points were selected:

 

LI 15 Jian Yu, SI 9 Jian Zhen, SJ 14 Jian Liao, SI 10 Nao Shu, SI 11 Tian Zhong, LI 16 Ju Gu, St 38 Tiao Kou penetrating to UB 57 Cheng Shan, SJ 5 Wai Guan and LI 4 He Gu, LI 11 Qu Chi.

 

Table 1

Points Meridian/No. Location Function/Indication
1 Jian Qian Extrapoints 23 Midway between the end of the anterior axillary fold and LI 15, Jian Yu Pain in the shoulder and arm, paralysis of the upper extremities
2 Jian Yu LI 15 See table 5-1/Pic 5-1 See table 5-1
3 Jian Zhen SI 9 Posterior and inferior to the shoulder joint. When the arm is adducted, the point is 1 inch above the posterior end of the axillary fold Pain in the scapular region, motor impairment of the hand and arm
4 Jian Liao SJ 14 Posterior and inferior to the acromion, in the depression about 1 inch posterior to LI 15 Jian Yu, when the arm is abducted. Pain and motor impairment of the shoulder and upper arm
5 Nao Shu SI 10 When the arm is adducted, the point is directly above SI 9 Jian Zhen, in the depression inferior to the scapular spine Swelling of the shoulder, aching and weakness of the shoulder and arm
6 Tian Zhong SI 11 See table 5-1/Pic 5-2 See table 5-1
7 Ju Gu LI 16 In the upper aspect of the shoulder, in the depression between the acromial extremity of the clavicle and the scapular spine Pain and motor impairment of the upper extremities, pain in the shoulder and back
8 Tiao Kou St 38 2 inches below St 37 Shang Ju Xu, midway between St 35 Du Bi and St 41 Jie Xi. Numbness, soreness and pain of the knee and leg, weakness and motor impairment of the foot, pain and motor impairment of the shoulder, abdominal pain
9 Cheng Shan UB 57 Directly below the belly of m. gastrocnemius, on the line joining UB 40 Wei Zhong and tendo calcaneus. About 8 inches below UB 40. Low back pain, spasm of the gastrocnemius, hemorrhoids, constipation, beriberi
10 Wai Guan SJ 5 See table 5-1/Pic 5-3 See table 5-1
11 He Gu LI 4 See table 3-1/Pic 3-4 See table 3-1
12 Qu Chi

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Fig. 5

 

 

Fig. 6

 

 

Fig. 7

 

 

Fig. 8

 

 

 

To treat Martha, I applied the heating pad to her right shoulder for approximately 20 minutes.  This increased the flexibility of the tendon underneath. Then, I inserted the needles into the above acupuncture points. After 30 minutes of acupuncture treatment, I gave her a deep massage, and she was told to raise her shoulder and perform other range of motion exercises. The patient underwent my treatment for a total of 10 visits.  Afterwards, she reported that her right shoulder pain and range of motion had improved greatly.

 

 

Tips for acupuncturists:

  1. Instruct the patient to sit down and relax.  First, insert the needle into the Qu Chi tips toward to the shoulder about 1.5 inches deep, causing the energy to transmit up to the shoulder.  Then insert the needles into the points of Jian Yu, Jian Zhen, Jian Liao, and Tian Zhong. Insert the needle into Tiao Kou so that it penetrates to Cheng Shan.  During the treatment, scratch the handles of needles, and make sure the patient feels this energy sensation from the needle tips spreading to the shoulder.
  2. Tell the patient to slowly raise his/her arm up to the head, and move the arm around. Usually, the patient will feel instant relief from the pain.

Tips for patients:

  1. Do range of motion exercises for 20 minutes every morning taking a hot bath or shower. The hot water increases the blood circulation and energy flow and will allow for the best range of motion and the least pain when doing these exercises.
  2. Purchase a heating pad and apply it to the shoulder for 20 minutes. Do the range of motion exercises again.
  3. The main goal is to increase the range of motion of the shoulder.  The second goal is to decrease the pain in the shoulder.
  4. Try to get an acupuncture treatment as soon as possible; do not wait.  Without treatment, it may take a few years for natural recovery, and in some cases range of motion will never fully return.

57. Headaches and Acupuncture Treatment

Aug 17, 2014   //   by drxuacupuncture   //   Blog, Case Discussions, Uncategorized  //  No Comments

News Letter, August, 2014, © Copyright

 

Jun Xu, M.D. Lic. Acup., Hong Su, C.M.D., Lic. Acup.

www.rmac.yourmd.com; www.drxuacupuncture.co

Rehabilitation Medicine and Acupuncture Center

1171 East Putnam Avenue, Building 1, 2nd Floor

Greenwich, CT 06878

Tel: (203) 637-7720

 

Intolerable Headache

Joan T. is a 16-year-old-girl.  She was brought by her mother, come to me for severe headache.  Joan started to have headache since age 12 when she started to have her period.  Her mother and herself told to me her headache is very severe, when she has four or five days per week.  The pain is dull and affects both sides of the temporal area and also focussed on the left eye with very deep pain, sometimes the pain will start from the neck shooting up to the temporal area.  The pain is so severe and very often the pain prevent her go to school.  Because of so many days four to five days a week, so if she will go to school she always call her mom to pick up her back to home, which interferes her study so much and one day her mother decided to bring her home in a American way to teach her the home school, so her mother borrowed so many books and stated to teach her at home and her mother quit her job.  She taught her mathematics, English, and world history and physics etc. However, now she is 16 years old, junior in high school.  It is a time for her to prepare her college entrance exam and prepare all the application to the college.  However, at this time her headache is getting severe and she could not think whenever she started she feels headaches and she had poor sleep and now she is very stressed, always crying and when she came to my office she was very depressed and she did not want to talk and because of the severe headaches and stress that she started to eat all the junk food so she looks very obese.  Her mom reports she went to all different kind of doctors, everybody gave her different medications, however, none medication helped her.  Her SAT exam will commence within two months and, however, she even did not finish one book preparation for her SAT exam, so her mom is very frustrated and brought her to me to evaluate and treat.

 

By physical examination, this was a slight obese young girl, very depressed and stressed. She spoke in a low tone; she did not like light, felt pain by touching her temporal area and back of the scalp, i.e. the occipital area.

 

The patient might have one of the following three types of primary headache, i.e., tension headaches, cluster headache, and migraine. She might as well have a mix of the two or three of the following headache.

Tension headache:

 

Tension headache is the most common type of chronic frequent headaches.  The symptoms of tension headache include the steady pain on both side of the head and with feeling of pressure and tightness around head and as a band is put tightly around it.  The pain usually increased over period of hours when the pain gets worse, which might develop pulsating quality.  The pain radiates from neck, back, eyes or other body parts.

 

 

 

 

 

Cluster headache:

 

Cluster headache is often described as a sharp, penetrating or burning sensation on the one eye.  The patients always state the pain is focused on one eye like somebody punched her or his eye and this pain is sudden onset without warning within a few minutes excruciating pain develops and people with the cluster headaches appears restless and the pain is so severe, some patients report the pain is even worse than childbirth.  The cluster headache usually lasts about 2 to 12 weeks, some chronic cluster headache may continue for more than a year.  These sometimes go with seasonal change.

 

 

 

 

 

 

 

 

 

Migraine Headache:

http://www.epainassist.com/images/Migraine-Headache.jpg

A migraine headache is a throbbing or pulsating headache that is often one side and associated with nausea and vomiting, and sensitive to light, sound, and smell with sleep disruption and depression.  These attacks are very often recurrent and do not change with age, sometimes develop a chronic migraine headache.

 

There are two types of migraine headache, migraine with aura and migraine without aura.  Most auras are visual and are described as bright shining light around objects or at the edges of field of vision or zig‑zag lines with wave image or hallucinations, some may experience temporary vision loss and motor weakness, speech, or language abnormalities, dizziness, vertigo, tingling, or numbness

The causes of headaches are usually different.

The causes of tension headaches are usually caused by stress, muscular tension, and gouty arthritis on the neck or spine, postural changes, vascular dilatation, protracted coughing or sneezing and fever and depression and temporal mandibular joint disorder etc.

 

The cause of the cluster headaches is unknown, however, cluster headache also well known to be triggered by alcohol, nitroglycerin, or similar drugs.

 

The cause of migraine headaches is unknown either.  It is very often.  There is a family history of disorder and migraine headache can be triggered with many stimulants for example alcohol, weather, altitude, exertion, food, and color and contrasting pattern, hormonal change, hunger, lack of sleep, medicine, perfume and stress etc.

 

From the western medicine point of view, there is many different kind or medications to treat headaches. For example, Topamax, Imitrex are using for migraine headaches with some successful cases. However, beta blockers, antiseizure medication, calcium channel blockers, tricyclic antidepressants, and analgesics such as aspirin, ibuprofen, acetaminophen etc are tried to treat migraine, cluster, and tension headaches. However, most of these drugs can not provide significant improvement for above headaches.  Therefore, more and more patients are starting to look for alternative treatments.  Acupuncture is one of the best therapies for the headaches.

 

Chinese medicine classifies headaches into two categories:

 

1.         External wind attack headaches: the headaches are caused by external factors, such as wind cold and wind heat. The headaches usually have a character of acute onset and very severe and constant attack.

 

Wind Cold: it shows periodic attack, the pain always is connected with neck and upper back and aversion to wind and cold, the head feels heavy, likes to have a band to tight around the head. The patient does not feel thirsty, and have thin and white coating on the tongue with floating pulse.

 

Wind Heat: feels expending headache from inside of the head, accompanied with fever and aversion to heat and wind, reddish face and eye, feels thirsty, constipation, yellowish urine, red tongue body with yellow coating on the tongue and floating pulse.

 

2.         Internal organ dysfunction headaches:  internal headaches usually are slowly onset and the pain is mild and sometimes feels emptiness within the head. When patients are on stress and overwork, the pain will be worse.  The pain is on and off and usually last for long time.

 

According to traditional Chinese medicine, head is the collection of all the Yang Meridians.  The six Yang Meridians all distribute to the head and face and also liver Meridians go up to the top of the head, therefore, headaches can be diagnosed based on the meridian distribution.  If we know the Meridians distribution, so then we will be easier to make clear diagnosis and treatment.

 

1.         Tai Yang (Urinary Bladder) meridian headache usually located at top of the head and back of the head and connected to the neck.

2.         Yang Ming (Large Intestine) meridian headache usually is on front of the head, i.e. the forehead including upper portion of the eye.

3.         Shao Yang (Gall Bladder) meridian headache usually is on the bilateral temporal area and radiates to the ear.

4.         Jue Ying (Liver) meridian headache usually is on the top of the head sometimes connecting to the eyes and frontal head. (Large Intestine) meridian headache

 

Acupuncture treatment for headaches:

 

First ask the patient the location of the headache and the severity of the headache, i.e. find out which internal organ shows dysfunction.

Second ask the patient about their accompanied symptom, differentiate the wind cold from the wind heat.

 

Figure 1

Figure 2

Figure 3

 

Figure 4

 

Figure 5

Figure 6

 

1. For Tai Yang (Urinary Bladder) meridian  headache, i.e. the headache locates on top of the head and back of neck.   We choose the following,  GB20 Feng Chi and DU16 Feng Fu and DU19 Hou Ding and BL9 Yu Zhen and BL60 Kun Run and SI3 Hou Xi.

Points Meridan/Number Location Function/Indication
1 Feng Chi Gall Bladder  20 In the depression between the upper portion of m. sternocleidomastoideus and m. trapezius, on the same level with Fengfu (Du 16) Headche, vertigo, insomnia, pain and stiffness of the neck, blurred vision, glaucoma, red and painful eyes, tinnitus, convulsion, epilepsy, infantile convulsion, febrile diseases, common cold, nasal obstruction, rhinorrhea.
2 Feng Fu Du  16 Directly 1 inch above the mid point of the posterior hair line, directly below the external occipital protuberance, in the depression between m. trapezius of both sides Headache, neck rigidity, blurring of vision, epistaxis, sore throat, post-apoplexy aphasia, hemiplegia, mental disorders.
3 Hou Ding Du  19 On the midline of the back of head Headache, vertigo, mania, epilepsy
4 Yu Zhen Urinary Bladder  9 1.3 inch lateral to midline of the body, on the lateral side of the superior border of the external occipital protuberance Headache, neck pain, dizziness, ophthalmalgia, nasal obstruction
5 Kun Lun UrinaryBladder  60 In the depression between the external malleolus and archillus tendon Headache, blurring of vision, neck rigidity, epistaxis, pain in the shoulder, back and arm, swelling and heel pain, difficult labor, epilepsy
6 Hou Xi Small Interstine  3 On the ulnar side, proximal to the 5th metacarpophalangeal joint, at the end of the transverse crease. Pain and rigidity of the neck, tinnitus, deafness, sore throat, mania, acute lumbar sprain, night sweat, fever, contracture and numbness of the finger, shoulder and elbow pain

 

 

 

 

  1. For Yang Ming ((Large Intestine) meridian headache, i.e. the headache locates on the front of the head, i.e. the forehead including upper portion of the eye. The acupuncture points are Yin Tang  and Tai Yang (Extraordinary Points), Lu 7 Lie Que, LI 4 He Gu, GB 14 Yang Bai

 

 

 

Points Meridan/Number Location Function/Indication
1 Yin Tang Extraordinary Point Midway  between the medial ends of the two eyebrows. Headache, head heaviness, epistaxis, rhinorrhea, infantile convulsion, frontal headache, insomnia
2 Tai Yang Extraordinary Point In the depression about 1 inch posterior to the midpoint between the lateral end of the eyebrow and the outer canthus Headache, eye diseases, deviation of the eyes and mouth
3 Lie Que Lung  7 Superior to the styloid process of the radius, 1.5 inch above the transverse crease of the wrist. Cough, pain in the chest, asthma, hemoptysis, sore throat, spasmodic pain of the elbow and arm
4 He Gu Large Intestine   4 On the dorsum of the hand between th e1st and 2nd metacarpal bones, approximately in the middle of the 2nd metacarpal bone on the radial side. Headache, pain in the neck, redness swelling and pain of the eye, epistaxis, nasal obstruction , rhinorrhea, toothache, deafness, swelling of the face, sore throat, arotitis, trismus, facial paralysis, febrile die\seases with anhidrosis, hidrosis, abdominal pain, dysentery, constipation, amenorrhea, delayed labour, infantile convulsion, pain, weakness and motor impairment of the upper limbs.
5 Yang Bai Gall Bladder  14 On the forehead, 1 inch directly above the midpoint of the eyebrow Headache, pain of the orbital ridge, eye pain, vertigo, twitching of th eyelids, ptosis, tearing

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

For Shao Yang (Gall Bladder) meridian headache, i.e. the headache usually is on the bilateral temporal area and radiates to the ear. The following points are chosen, GB 20 Feng Chi, Extra Point 1 Tai Yang, SJ 5 Wai Guan, ST 8 Tao Wei, GB 38 Yang Fu, GB 39 Jue Gu.

 

Points Meridan/Number Location Function/Indication
1 Feng Chi Gall Bladder  20 As above
2 Tai Yang Extraordinary Point As above
3 Wai Guan San Jiao  5 2 inches above the transverse crease of the dorsum of wrist, between the radius and ular. Fever, headache, cheek and neck pain, deafness, tinnitus, elbow and arm pain, hand tremor
4 Tou Wei Stomach  8 0.5 inch within the anterior hairline at the corner of the forehead Headache, blurring of vision, eye pain, tearing
5 Yang Fu Gall Bladder 38 4 inch above and slightly anterior to the tip of the lateral malleolus, on the anterior border of the fibula Migrane, pain in the outer canthus, axillary region, scrofula, lumbar, chest, hypochondriac and lateral leg.
6 Jue Gu Gall Bladder 39 3 inch above the tip of the external malleolus, 1 inch below Yang Fu Apolexy, hemiplegia, pain of the neck, abdominal distension, pain in the hypochondriac region, muscular atrophy of the lower limbs, spastic pain of the leg, beriberi.

 

 

 

 

 

.

 

 

 

 

  1. For Jue Ying (Liver) meridian headache usually the pain is on the top of the head

and many time it connects to the eyes and frontal head. Du 20 Bai Hui, Liv 3 Tai Chong, Lung 7 Lie Que

Points Meridan/Number Location Function/Indication
1 Bai Hui Du 20 On the midline of the head, cross the line of  two ear tips Headache, vertigo, tinnitus, nasal obstruction, aphasia by apoplexy, coma, mental disorders, prolapse of the rectum and the uterus
2 Tai Chong Liv 3 On the dorsum of the foot, in the depression distal to the junction of the first and second metatarsal bones. Headache, dizziness and vertigo, insomnia, congestion, swelling and pain of the eye, depression,, infantile convulsion, deviation of the mouth, pain in the hypochondriac region, uterine bleeding, hernia, enuresis, retention of urine, epilepsy, pain the anterior aspect of the medial malleolus
3 Lie Que Lung  7 See above See above

 

 

 

 

 

 

 

 

 

If  the patient with above symptoms accompanied with the wind cold or wind heat signs, we will add the following points

 

  1. Wind Cold: GB 20 Feng Chi, Extra Point Tai Yang , ST 8 Tou Wei,  GB 8 Shuai Gu, UB 12 Feng Meng, UB 60 Kun Lun.
Points Meridan/Number Location Function/Indication
1 Feng Chi Gall Bladder  20 See  above
2 Tai Yang Extraordinary Point See  above
3 Tou Wei Stomach  8 See above
4 Shuai Gu Gall Bladder 8 Superior to the apex of the auricle, 1.5 inch within the hairline. Migraine, vertigo, vomiting, infantile convulsion.
5 Feng Meng Urinary Bladder 12 1.5 inch lateral to the midline of the body, at the level of the lower border of the spinous process of the second thoracic vertebra Common cold, cough, fever and headache, neck rigidity, back pain
6 Kun Lun Urinary Bladder  60 See above

 

 

 

 

Points Meridan/Number Location Function/Indication
1 Feng Chi Gall Bladder  20 See  above
2 Tai Yang Extraordinary Point See  above
3 Tou Wei Stomach  8 See above
4 Shuai Gu Gall Bladder 8 See above
5 Da Zhui Du 14 Below the spinous process of the seventh lumbar vertebra, approximately at the level of the shoulders Neck pain and rigidity, malaria, fever, epilepsy, cough, asthma, common cold, back pain and stiffness
6 Wai Guan San Jiao  5 See above

 

 

 

 

 

 

 

 

Wind Heat: GB 20 Feng Chi, Tai Yang, St 8 Tou Wei, GB 8 Shuai Gu, Du 14 Da Zhui, SJ 5 Wai Guan,

Acupressure tips for patients:

 

  1. If you have headache, please differentiate the site of the headache, i.e. identify if you have Tai Yang, Yang Ming, Shao Yang, or Jue Ying headache.
  2. After you identify the site of the headache, then try to locate the points by following the above tables and pictures.
  3. Acupressure the points with your knuckle, press with the comfortable pressure on the points, count 20 counts then change to another points. You should use the symmetric points at the same time.
  4. Your acupressure points mainly locate on the head, use the head points as the major acupressure points. You may ask your friends or family members to help you with moderate acupressure.

 

Acupuncture Tips for Practitioners:

 

  1. The most important is to identify which meridian headache your patient belongs to, i.e. Tai Yang, Yang Ming, Shao Yang, or Jue Ying.
  2. Identify the external type, i.e. wind cold or wind heat. If you could combine the meridian with the external type, your acupuncture effects will be much more than the average acupuncturists.
  3. The distal points, i.e. on the hands and feet, are very important for your treatment. Please do not ignore the distal points.
  4. Please put your patients in a quite and low illuminated room, with electrical stimulation for 30 min.

5.   Many headaches may be triggered by occipital neuralgia, trigeminal neuralgia, common cold, sinusitis and allergy etc.  For those headaches secondary to the above, we have to treat the original trigger. We should treat the sinusitis, occipital neuralgia, trigeminal neuralgia, common cold, allergy, etc.  If we can effectively treat the original trigger of  the primary headache, our patient’s recovery rate will be much higher the average of acupuncturists. For many years,  99% of my patients felt much improved after my treatment because I not only treat the symptom of headache, but I also treat the trigger factors.

Joan’s headache is very complicated. From the western medicine point of view, her headache belongs to migraine headache. However, her headache always triggered by occipital neuralgia and worsen with her hormone and menstruation.  Every time when she has hormonal change and also sometimes occipital nerve pain, her headache symptom would get worse. Therefore, she has four to five attacks per week.

After I made a clear diagnosis, first I used GB20, DU16, and Bai Hui and also Tai Yang,  and LI4.  The patient underwent my treatment three times a week for about two months and she also was injected with cortisone to block her left and right occipital nerve pain, her headache is much-much better. After my treatment,  the patient took her SAT test and applied for college, she was accepted into the Boston College and after two years follow up,  her mother reported that Joan is great and she has no any major headache attack. She survived her college study.  Her mother is very-very thankful to me.

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