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55. Dr. Xu Africa Medical Mission 2014

Feb 27, 2014   //   by drxuacupuncture   //   Blog, Uncategorized  //  No Comments

Dear Friends and Patients,

As you many of you may  know,  I will go to Africa again to treat Africa patients  in April, 2014.  I thank you for all your support of my 2013’s medical mission. In order to help the poor children in Africa, I will have a fundraising party in Christ Church Greenwich on March, 16, Sunday at 4:00 PM.  We would like to build up a trade school. We will teach them for carpentry, electrician, plumbing and art. I hope the school will be self-sufficient in someday.   Your purchasing the tickets will greatly help these poor Africa children as well as me! You will get 40% discount of the original price if purchased before March 10, 2014. If you can not go for any reason, you may donate through the following website.

 

 

Where: Christ Church Greenwich,  254 E Putnam Avenue, Greenwich, CT

When: March 16, Sunday, 4:00 to 8:00pm

Where to buy the tickets: www.africamission2014.eventbrite.com

Ticket Price: Regular: $100, Children 5 to 12: $50, under 5: free, VIP: $500, 40% discount if purchased before March 10, 2014. You may also buy the ticket at the door.

Usage of the fund: 100% go to the construction of the trade school in Senegal. All my team members will pay our own airfare, room and board.

Programs:

1. Brief report of 2013 Africa trip and future project.

2. Authentic Africa Food and Art.

3. Silent Art Auction

4. Professional Chinese Acrobats.

5. Church Chorus.

Please add this page to your facebook, linkedin,  and other connections, or forward to your friends, church, and colleagues.

Please pray for us, I  will take a transfer with a small airplane from Senegal to Guinea Bissau, because there is no direct flight from US to Guinea Bissau. Please pray for our safety on the trip. We may face a lot of challenges, such as contaminated food and water, gangsters on the road, high temperatures,  very small room in the base for us to stay, etc.

Thank you very much for your help! This is the time for  you to support me! I will help you in my office.

Here is the link for my Africa Mission Trip 2013: http://www.drxuacupuncture.co/?p=2268

Best wishes to all of you!

Jun Xu, MD

 

 

 

 

 

 

 

54. Acupuncture and Peripheral Polyneuropathy

Jul 28, 2013   //   by drxuacupuncture   //   Blog, Case Discussions, Uncategorized  //  No Comments

News Letter, Vol. 5 (6), July, 2013, © Copyright

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

Robert Blizzard III, DPT

www.drxuacupuncture.co

Rehabilitation Medicine and Acupuncture Center

1171 East Putnam Avenue, Building 1, 2nd Floor

Greenwich, CT 06878

Tel: (203) 637-7720,  Fax: (203)637-2693

Peripheral Polyneuropathy

Fig 1 http://www.nlm.nih.gov/exhibition/aidsephemera/button1.html

Joanna, a 46 year-old female, has been feeling numbness into her feet for the past month.  She felt uncomfortable to drive and walk because of decreased sensation at both feet. She has been losing her balance as sensation is decreasing in her feet.  She never had any of these issues before, always having great balance, as she was a gymnast when she was younger but since her collegiate gymnastic career ended she has not been as active and slowly has been gaining weight.   She was diagnosed with diabetes about 20 years ago and continues to use insulin.  Joanna had a few mild falls because she started to lose feeling at her both feet. Her husband found her right foot bleeding, however, Joanna reports never feeling that she stepped on anything. Joanna went to her physician who examined her and she was found to have decreased sensation at both hands and feet with glove and stock distribution.  Both her feet showed a little black color with lost hair and dry skin. She then was referred to me for eval and treatment. I performed Nerve Conduction Velocity and Electromyography Tests, which conformed Joanna had peripheral neuropathy.

Peripheral neuropathy is damage to the nerves outside of the central nervous system.  The peripheral nervous systems transmit messages to and from the extremities to the spinal cord and brain.  Damage to the sensory nerves would result in slowed or lost relay of information on touch, pain, temperature, position and vibration.  If the motor aspect were damaged then muscle contraction or muscle tone would be impacted, even the supplied muscle would be atrophy.  Autonomic nerve damage would decrease the ability of vital organs or process that control blood pressure, sweating, heart rate to list a few.

The most common peripheral neuropathy is diabetic; as in the United States between 60-70% of diabetics have some form of damage to the nervous system.  It is the result of poorly controlled blood sugar levels. Though less common, diabetes can also cause mononeuropathy, often characterized by weakness of the eye or of the thigh muscles. Peripheral neuropathy can be inherited caused by genetic code mutations, with Charcot-Marie-Tooth disease being the most common inherited peripheral neuropathy.  Other identified causes include traumatic injuries, infections, alcohol abuse, external pressure on nerves, nutritional deficiency, metabolic problems or toxin exposure.

These are the most common symptoms of peripheral polyneuropathy:

Tingling

Numbness

Loss of sensation in the hands and feet

Burning, pins and needles sensation

 

Because people with chronic polyneuropathy often lose their ability to sense temperature and pain, they can burn themselves and develop open sores as the result of injury or prolonged pressure. If the nerves serving the organs are involved, diarrhea or constipation may result, as well as loss of bowel or bladder control. Sexual dysfunction and abnormally low blood pressure also can occur.

 

Joints are particularly vulnerable to stress in people with polyneuropathy because they are often insensitive to pain.

One of the most serious polyneuropathies is Guillain-Barre syndrome, a rare disease that strikes suddenly when the body’s immune system attacks nerves in the body. Symptoms tend to appear quickly and worsen rapidly, sometimes leading to paralysis. Early symptoms include weakness, tingling, and loss of sensation in the legs that eventually spreads to the arms. Blood pressure problems, heart rhythm problems, and breathing difficulty may occur in critical cases. However, despite the severity of the disease, recovery rates are good when patients receive treatment early.

Current tests for peripheral neuropathy include:

Blood Tests:  will determine if levels are out of norms for vitamins, blood sugar or if organs are not operating properly

Imaging Tests: will rule out other issues such as herniations, tumors or possible other explanation of symptoms

Nerve Function Test:  Nerve Conduction Velocity (NCV) and Electromyography (EMG) tests will differentiate between muscle and nerve disorders

Nerve Biopsy: will determine what is damaging the nerve, though is often not necessary for diagnosis

As with many conditions, ensuring a healthy lifestyle will be beneficial.  Eating a balanced diet, maintaining a healthy weight, daily-supervised exercise regime are the staples.  Lifestyle changes that are crucial to modify include excessive alcohol consumption and quitting smoking as blood vessels are constricted and will limit nutrient delivery to the peripheral nerves impeding recover.  Diabetics need to ensure proper self-care of their feet as sensations are dampened to begin with and need daily inspection to examine for any wounds.

 

Systemic disease will be more complicated to treat, as strict control is needed.  For diabetics, if blood glucose levels are not maintained then continued nerve damage is likely to occur.  Autoimmune and inflammatory conditions can lead to neuropathy that can be controlled with prednisone, an immunosuppressive drug.  Inflammation can also be limited with procedures such as plasmapheresis, in which the blood is removed from the body, cleansed in a lab then injected back into the body.  This process limits inflammation helping to suppress abnormal immune system activity.

Physical Therapy

A physical therapist can help in selecting mechanical aids that will reduce pain, improve function and decrease physical impairments.  A wrist brace can compensate for muscle weakness or alleviate compression on a nerve.  Proper orthopedic shoe selection can greatly improve walking performance by limiting risk of foot injuries and enhancing balance.

Depending upon the root of the neuropathy and the symptoms present, the physical therapy protocol varies significantly.  Improving balance and strengthening muscles around the ankle and core are often very useful.  This exercise should be started on a flat surface (not shown) then progressed to a foam pad.  Steady balance needs to be mastered before attempting to reach forward with the feet or hands.  Try 5 reps each direction of 12– 3– 6 and 9 O’clock repeated on both legs for 5 total sets.

 

Fig 2 www.optp.com

 

A movement such as the front plank is a terrific core exercise that will improve posture during the day.  Patients are encouraged to keep a straight or neutral body alignment from their ear down through their ankles while holding this position.  Set a timer for 2 minutes, holding as timer is running and when a break is needed hitting pause on the timer until 2 minutes of holding the plank is up.

 

Fig 3 http://www.fitnessforhumans.com/2011/05/19/abdominal-planks-for-core-strength/

 

Surgical intervention if needed can provide immediate relief when symptoms are caused by compression or entrapment injuries. Such surgery would be to repair a herniated disc relieving pressure on the nerve.  Other examples or surgery would be if a tumor was impinging a nerve or if the nerve entrapment is a result or constricting ligaments or tendons.

 

Acupuncture Treatment

Acupuncture may not control the blood sugar and/or treat the cause of peripheral polyneuropathy. However, acupuncture is a very good tool to alleviate the symptom of tingling, numbness, loss of sensation in the hands and feet and burning, pins and needles sensation.

Peripheral Nerve- numbness, tingling, ants climbing, glove and stock distribution, cold extremities, foot drop, decreased knee and ankle reflex, no sweating,  sometimes, feels weakness and muscle atrophy.

The treatment should focus on both upper and lower extremities. The points selected are

  • Upper extremity: LI 15 Jian Yu, LI 11Qu Chi,  SJ 5 Wai Guan, LI 4 He Gu,  SI 4 Wan Gu, SJ 4 Yang Chi, and extra points Ba Xie,
  • Lower Extremity: St 31 Bi Guan, St 34 Liang Qiu, GB 31 Feng Shi,  St 36 Zu San Li, St 41 Jie Xi, and extra points Ba Feng.

Many patients may have depression and low energy, therefore, the points on the Brain are very important, I usually choose: Du 21Bai Hui, Si Sheng Chong, GB 8 Shuai Gu, Tai Yang,  Du 23 Shang Xing, Ying Tang, etc.

For Coldness at feet and hands, I also choose Ren 4 Guan Yuan, Ren 6 Qi Hai, UB 20 Pi Shu, UB 23 Shen Shu.

For poor balance and unsteady gait:  SI 19 Ting Gong, GB 2 Ting Hui, GB 20 Feng Chi, Ren 16 Feng Fu, Du 21 Bai Hui, Si Sheng Chong

For GI symptom, such as: bloating, abdominal pain, diarrhea and constipation, St 36 Zu San Li, St 37 Shang Ju Xu,  St 39 Xia Ju Xu, Ren 12 Zhong Wan,  PC 6 Nei Guan, UB 21 Wei Shu and UB 20 Pi Shu.

 

 

 

 

 

 

 

 

 

Fig 4

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Fig 5

 

 

 

 

 

 

 

 

Fig 6

 

 

 

 

 

 

 

 

fig 7

 

 

 

 

 

 

Fig 8

The treatment course of Joanna:

Joanna underwent my treatment 3 x per week for 4 weeks, she first felt less burning pain, and a steadier gait, but she still felt numbness and tingling sensation in both feet. After two weeks of treatment she started to feel warmth in both feet, she could sleep better. After finishing 4 weeks of treatment she walked much better, and she drove smooth and steady. She then continued her maintenance program once a week for 8 weeks, she is much more comfortable to walk and drive now. Her sensation in both feet was much better, she no longer had a burning sensation, but she still felt mild numbness. She was told to strictly control her blood sugar and gradually her numbness and tingling sensation disappeared.

Tips for patients:

  1. The most important treatment is control of blood sugar.
  2. You should always wear white socks, if you have any wound in your feet, you will find it right away by checking your socks.
  3. Clean and check your feet with mirror every day, you will find the wound and take care of it right away.
  4. Keep balance training, you will keep your balance much better with the progress of peripheral Polyneuropathy.
  5. Massage your feet as following, 15 min 3 x per day, which will greatly help  your symptom.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Fig 9 www. overstock.com

Tips for Acupuncturists:

  1. Always use electrical stimulation.
  2. Using plum – blossom needle to tap the feet around the plantar feet may also receive good result.
  3. Always teach patients to check their wound in the feet and hands.

 

 

52. Acupuncture and Rheumatoid Arthritis

Apr 29, 2013   //   by drxuacupuncture   //   Blog, Case Discussions, Uncategorized  //  No Comments

News Letter, Vol. 5 (4), April, 2013, © Copyright

 

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

Robert Blizzard III, DPT

www.drxuacupuncture.co

Rehabilitation Medicine and Acupuncture Center

1171 East Putnam Avenue, Building 1, 2nd Floor

Greenwich, CT 06878

Tel: (203) 637-7720

Fax: (203)637-2693

 

Acupuncture and Rheumatoid Arthritis

 

Fig. 1 Hang RA http://www.fsb555.com

Sandy, a 45 year-old woman, complained of bilateral hand and wrist pain on-and-off for many years. Recently for a month now, she felt both hands had constant pain and were tender, warm and swollen.  She woke up with morning stiffness that may last for hours and felt firm bumps of tissue under her both forearm accompanied with fatigue, mild fever and gradually weight loss. She visited her PCP and was given naproxen to reduce her inflammation and pain, however, she felt no improvement. She was referred to a rheumatologist, who ordered x-ray images and rheumatoid factor test.  Both were positive for Rheumatoid Arthritis, therefore, the diagnosis was confirmed. The patient was given methotrexate and felt better for morning stiffness and swelling, however, she had many side effects, such as, nausea, vomiting, hair loss, etc. Because of above complaints, she came to me for evaluation and treatment.

 

Rheumatoid Arthritis (RA) is a chronic, long-term disease that causes pain, stiffness, swelling and limited motion and function of many joints. While RA can affect any joint, the small joints in the hands and feet tend to be involved most often. Inflammation sometimes can affect organs as well, for instance, the eyes or lungs. As the disease progresses, symptoms often spread to the knees, ankles, elbows, hips and shoulders. In most cases, symptoms occur in the same joints on both sides of your body.

The stiffness seen in active RA is most often worst in the morning. It may last one to two hours (or even the whole day). Stiffness for a long time in the morning is a clue that you may have RA, since few other arthritic diseases behave this way. For instance, osteoarthritis most often does not cause prolonged morning stiffness.

Other signs and symptoms that can occur in RA include:

Loss of energy

Low grade fever

Loss of appetite

Dry eyes and mouth from a related health problem, Sjogren’s syndrome, etc

Firm lumps, called rheumatoid nodules, which grow beneath the skin in places such as the elbow and hands

Fig .2 Synovium  http://www.rheumatology.org/practice/clinical/patients/diseases_and_conditions/ra.asp

The normal joint structure appears on the above left. On the right is the joint with rheumatoid arthritis. RA causes synovitis, pain and swelling of the synovium (the tissue that lines the joint). This can make cartilage (the tissue that cushions between joints) and bone erode, or wear away.

RA is an autoimmune disease. This means that certain cells of the immune system attack healthy tissues — the joints in RA, cause the inflammation in the synovium, the tissue that lines the joint. Immune cells release inflammation-causing chemicals. These chemicals can damage cartilage (the tissue that cushions between joints) and bone.

Rheumatoid arthritis affects the wrist and the small joints of the hand, including the knuckles and the middle joints of the fingers.

 

Fig. 3 RA Hand Deformity  www.eastlady.cn

Rheumatoid arthritis signs and symptoms may vary in severity and may even come and go. Periods of increased disease activity, called flares, alternate with periods of relative remission — when the swelling and pain fade or disappear. Over time, rheumatoid arthritis can cause joints to deform and shift out of place.

Diagnosis of RA depends on the symptoms and results of a physical exam, such as warmth, swelling and pain in the joints. Some blood tests also can help confirm RA. Telltale signs include:

Anemia (a low red blood cell count)

Rheumatoid factor (an antibody, or blood protein, found in about 80% of patients with RA in time, but in as few as 30% at the start of arthritis)

Antibodies to cyclic citrullinated peptides (pieces of proteins), or anti-CCP for short (found in 60–70% of patients with RA)

Elevated erythrocyte sedimentation rate (a blood test that, in most patients with RA, confirms the amount of inflammation in the joints)

X-rays can help in detecting RA, but may not show anything abnormal in early arthritis. Even so, these first X-rays may be useful later to show if the disease is progressing. Often, MRI and ultrasound scanning are done to help judge the severity of RA.

 

Fig. 4 Normal Hand X-ray http://gb.123rf.com/photo_751289_hands-on-x-ray-film.html

Fig 5.  RA hand x-ray

There is no single test that confirms an RA diagnosis for most patients with this disease. (This is above all true for patients who have had symptoms fewer than six months.) Rather, a doctor makes the diagnosis by looking at the symptoms and results from the physical exam, lab tests and X-rays.

There is no cure for RA. The goal of treatment is to lessen your symptoms and poor function. No single treatment works for all patients. Many people with RA must change their treatment at least once during their lifetime. The treatment must start as earlier as  possible.

A goal of physical therapy is to help make the muscles stronger and the improve the motion of the joints.  Warming up painful joints is very important in managing pain and priming the body for more exercise.  This can be accomplished with moist heating pads, a whirlpool or warm shower.  Following the warm-up, aerobic exercise such as a stationary bike, elliptical, or even arm bike will continue to work the body.  Other arthritis friendly options are aquatic exercises, tai chi or yoga routines.

 

Fig. 6 http://www.tospt.com/aquaticTherapy

It is important to be flexible with the workout routine, as if after the warm-up and aerobic exercise the joints are still very sore, change to strengthen a body part with less discomfort.  However, do not get in a habit of skipping the warm-up and light aerobic exercise if a joint is tender, as often just these two steps will greatly improve how the joint is feeling.  Below are a few range of motion and light strengthening exercises to help the hand that can be performed daily.

Fig. 7 http://morphopedics.wikidot.com/physical-therapy-management-of-rheumatoid-arthritis

West Medicine Treatment:

Good control of RA requires early diagnosis and, at times, aggressive treatment. Thus, patients with a diagnosis of RA should begin their treatment with disease-modifying antirheumatic drugs — referred to as DMARDs. These drugs not only relieve symptoms but also slow progression of the disease. Often, doctors prescribe DMARDs along with nonsteroidal anti-inflammatory drugs or NSAIDs and/or low-dose corticosteroids, to lower swelling, pain and fever. DMARDs have greatly improved the symptoms, function and quality of life for nearly all patients with RA.

Common DMARDs include methotrexate (brand names include Rheumatrex® and Folex®), leflunomide (Arava), hydroxychloroquine (Plaquenil) and sulfasalazine (Azulfidine). Older DMARDs include gold, given as a pill — auranofin (Ridaura) — or more often as an injection into a muscle (such as Myochrysine). The antibiotic minocycline (e.g., Minocin, Dynacin and Vectrin) also is a DMARD, as are the immune suppressants azathioprine (Imuran) and cyclosporine (Sandimmune and Neoral). These three drugs and gold are rarely prescribed for RA these days because other drugs work better or have fewer side effects.

Patients with more serious disease may need medications called biologic response modifiers or “biologic agents.” They can target the parts of the immune system and the signals that lead to inflammation and joint and tissue damage. These medications are also DMARDs. FDA-approved drugs of this type include abatacept (Orencia), adalimumab (Humira), anakinra (Kineret), certolizumab (Cimzia), etanercept (Enbrel), golimumab (Simponi) infliximab (Remicade), rituximab (Rituxan) and tocilizumab (Actemra). Most often, patients take these drugs with methotrexate, as the mix of medicines is more helpful.

The best treatment of RA needs more than medicines alone. Patient education, such as how to cope with RA, also is important. Proper care requires the expertise of a team of providers, including rheumatologists, primary care physicians, physiatrist and physical and occupational therapists. You will need frequent visits through the year with your rheumatologist. These checkups let your doctor track the course of your disease and check for any side effects of your medications. You likely also will need to repeat blood tests and X-rays or ultrasounds from time to time.

Living with rheumatoid arthritis

 

It is important to be physically active most of the time, but to sometimes scale back activities when the disease flares. In general, rest is helpful when a joint is inflamed, or when you feel tired. At these times, do gentle range-of-motion exercises, such as stretching. This will keep the joint flexible.

 

When you feel better, do low-impact aerobic exercises, such as walking, and exercises to boost muscle strength. This will improve your overall health and reduce pressure on your joints. A physical or occupational therapist can help you find which types of activities are best for you, and at what level or pace you should do them.

 

Acupuncture Treatment:

 

Acupuncture is an excellent alternative way to treat your symptoms. It has no side effects and can be combined with traditional western medicine to relieve your symptoms. The choice of acupuncture treatment of RA  is as following,

Fig 8. Common used acupuncture  points on hands for RA patients

1.         Common used body points: Du20 Bai Hui,  GB8 Shuai Gu, UB9 Yu Zhen, Ht7 Shen Men, GB20 Feng Chi, UB15 Xin Shu, UB20 Pi Shu, UB18 Gan Shu, UB23 Shen Shu, St6 Zu San Li, Sp6 San Yin Jiao, Lv3 Tai Cong, UB2 Zan Zhu, Kid3 Tia Xi.

2.         Arthritis: Shoulder: LI 15 Jian Yu, SI 9 Jian Zhen, SJ 14 Jian Liao, SI 10 Nao Shu, SI 11 Tian Zhong, LI 16 Ju Gu  Wrist: LI5 Yang Xi and SJ 4 Yang Chi.  Hand: L11 Shao Shang, L10 Yu Ji, LI 1 Shang Yang, LI 2 Er Jian, Ht 9 Shao Chong, Ht 8 Shao Fu, SI Shao Ze, SI 2 Qian Gu, SI 3 Hou Xi, SI 4 Wan Gu, PC 9 Zhong Chong, PC 8 Lao Gong.   Knee: LI 4 He Gu, LI 11 Qu Chi, St 35 Du Bi, Nei Xi Yan, Sp 10 Xue Hai, St 34 Liang Qiu, He Ding, UB 40 Wei Zhong. Feet: St 45 Li Dui, St 44 Neiting, Sp 1 Yin Bai, Sp 2 Da Du Sp3 Tai Bai, Sp 4 Gong SunUB 66 Zu Tong Gu, UB 65 Zhi Yin, UB 65 Shu Gu.

3.         Neurological Symptoms: Fatigue, Depression and Poor Sleep: Major points: St 36 Zu San Li, PC6 Nei Guan,  LI4 He Gu, Ht7 Shen Meng, Sp6 San Yin Jiao, GB20 Feng Chi, Du20 Bai Hui, EX-HN1 Si Shen Cong, assistant points: Du14 Da zhui, Ren12 Zhong Wan, Ren14  Ju Que, Ren6 Qi Hai, Ren4 Guang Yuan, UB21 Wei Shu and UB23 Shen Shu.

4.         Heart Palpitation: PC6 Nei Guan, Ht7 Shen Men, UB15 Xin Shu, Ren14 Ju Que, UB14 Jue Yin Shu

5.         Dizziness: Si Shen Chong, Du20 Bai Hui, Du12 Shen Zhu, UB12 Feng Men, UB43 Gao Huang, Sp6 San Yin Jiao, St36 Zhu San Li, LI11 Qu Chi.

Sandy’s Treatment:

Sandy was treated with me for 2 x per week for 8 weeks. I first try to decrease her pain at the joints and body with the points of group 1 and 2 , then, I used the group 3 and 4 points to help her to improve her fatigue and depression, after about 2 month’s treatment, Sandy was put on maintenance treatment program once a week for 4 weeks, and she  felt much improved. Her pain scale decreased from 7/10 to 2/10. Her swelling at both hands is much relieved.

Tips for Patients:

1. Multiple Therapies are the best way to treat RA with combination of medicine, PT and Acupuncture.

2. Newer treatments are effective. RA drugs have greatly improved outcomes for patients. For most people with RA, early treatment can control joint pain and swelling, and lessen joint damage.

3. Seek an expert in arthritis: a rheumatologist. Expertise is vital to make an early diagnosis of RA and to rule out diseases that mimic RA, thus avoiding unneeded tests and treatments. A physiatrist who is an expert in RA also can design a customized treatment plan that is best suited for you. Therefore, the rheumatologist, working with the primary care physician and other health care providers, should supervise the treatment of the patient with RA.

4. Start treatment early. Studies show that people who receive early treatment for RA feel better sooner and more often, and are more likely to lead an active life. They also are less likely to have the type of joint damage that leads to joint replacement.

Tips for Acupuncturists:

1. Treat your patients as a whole person and long-term treatment is necessary. You should encourage your patient perform exercise, which will keep your patients’ mobility of hands and other joints.

2. Encourage your patients to have at least 8 weeks treatment. It is very important to have a long-term treatment to achieve the best results.

 

50. Acupuncture and Facial Rejuvenation

Feb 27, 2013   //   by drxuacupuncture   //   Blog, Case Discussions, Uncategorized  //  No Comments

News Letter, Vol. 5 (2), February, 2013, © Copyright

 

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

Robert Blizzard III, DPT

www.drxuacupuncture.co

Rehabilitation Medicine and Acupuncture Center

1171 East Putnam Avenue, Building 1, 2nd Floor

Greenwich, CT 06878

Tel: (203) 637-7720

Fax: (203)637-2693

Acupuncture and Facial Rejuvenation

 

Fig 2-1

Like most people in Western countries, Michelle, a 50 year old woman, loved to sun bathe for many years.  She gradually discovered that her skin appeared to have an increasing amount of dark spots as she began to age. She also complained of deeper wrinkles appearing on her upper lip, in the corner of her eyes, side of her mouth and nasolabial folds deepening with constant dryness of the skin that lacked shine. She also had difficulty falling asleep, remaining asleep without interruption, experienced fatigue, constipation, on and off hot flashes, irregular menstruation, lived a stressful life, and experienced cold limbs during the winter and in air condition rooms. She would like to try acupuncture and Chinese herbs to reduce her facial dark spots, wrinkles, and improve the quality of her facial skin.

In order to understand the formation of hyperpigmentation and wrinkles, we have to understand the skin structure and related modern research.

 

The hyperpigmentation, i.e. dark spots, is the darkening of an area of skin caused by increased melanin. The dark spots are the results of excessive sun exposure usually found on the hands and face; hormonal changes associated as pregnancy, menopausal changes and ingestion of birth control pills; genetic factor, such as freckles or drug reaction. Sometimes, acne vulgaris (severe acne/pimples) also leads to hyperpigmentation.

Wrinkles typically appear as a result of aging. Wrinkles are accelerated by habitual facial expressions, aging, sun damage, smoking, poor hydration, and various other factors.

Skin consists of three layers:

 

 

Fig 2-2

 

http://medicineworld.org/news/skin-news.html

 

  1. The outermost layer is the epidermis, which is made up of mainly dead, hardened skin cells that protect the body from outside elements.
  2. The next layer is the dermis, which contains a kind of tissue called collagen, as well as fibers and elastin that gives skin its elasticity.
  3. The innermost layer is the hypodermis, which is made of mostly fat that absorbs water to make the skin tissue nourished.

Many forms of hyperpigmentation are caused by an excess production of melanin by melanocytes at the epidermis. Besides the above mentioned causes, UV lights are the main reason to stimulate melanocyte activity; therefore, it is necessary to avoid excessive exposure to sun.

 

Wrinkles form in the epidermis and dermis. As we age, skin loses its ability to defend itself against the sun, smoking and the environment.

  1. The outermost layer of cells divide more slowly in older skin, making the epidermis thinner and lack the ability to hold moisture, which leads to fine lines in the skin’s surface.
  2. Deeper in the skin, the dermis, collagen and elastin break down and weakens the skin’s supportive structure.  Skin then looses its elasticity and the ability to stretch and spring back into a firm position.
  3. During this time, fat starts to disappear from the skin’s deepest layers, the hypodermis, which leads to sagging.

Together, these effects create deeper wrinkles, such as frown lines and furrows. In fact, 90 percent of the premature skin ageing wrinkles is from excessive exposure to the sun, not from the normal process of aging.  50 to 80 percent of skin damage caused by the excessive sun exposure occurs in childhood. Therefore, good sun protection should be a habit developed early on and applying sunscreen before going outdoors can help reduce wrinkles.

Another cause of premature skin aging is smoking. Smoking damages the skin’s collagen which causes inflammation and leaves telltale lines around the mouth. Smokers are five times more likely to have wrinkled facial skin than non-smokers.

Air pollution, smog and toxins in the air can also wreak havoc on your skin by breaking down vitamin E, a necessary vitamin for your skin’s health.  Genetics also play a role in skin health because it can determine when you’ll begin seeing crow’s feet around your eyes and laugh lines around your mouth.

How does Chinese Medicine treat patients with dark spots and deep wrinkles?

Chinese Medicine treats each patient as a whole person. Maintaining good skin isn’t just about beauty. It is also a health issue. More and more people pay attention not only to the wrinkles and dark spots but to their health. It is called life extension science or anti-aging medicine. Skin quality changes as the body’s health increases.

The Chinese approach to beauty has always been identified as being within.  In other words, beauty stems from what’s on the inside. As early as the Sung Dynasty (960AD-1270AD), Acupuncturists have employed rejuvenation practices for the Empress and other court subjects. The Chinese realized that by using the body’s inner qi (internal energy), and manipulating its channels, it may be used to initiate the healing processes and improve facial appearance.

Chinese Medicine treatment consists of the following parts:

  1. Whole body treatment: In order to maintain the balance of Yin-Yang in the body. The pulse will be maintained to identify any excess or deficiency of internal organs, such as the liver, kidney, heart, spleen and lung.
  2. Facial treatment: Chinese method focus on the layer of dermis, improve collagen and elastin production, increase muscle tone and dermal contraction by inserting needles to directly stimulate the productive cells of dermis.

 

There are twelve regular meridians and eight extra meridians in our body. The essence transformed from daily intake through our digestion system is carried to the face by normal meridians transportation. Healthy skin appearance includes: moisture, gloss, smoothness, and purity. It is supported by healthy organs and a normal functioning of body. Points selection is not only focus on the face but also other parts of the body as well.

Acupuncture is designed to free up chi, moving energy through the body. When the needles are applied to the face it stimulates production of collagen and elastin. By addressing other parts of the body in addition to the face, such as the feet, legs, arms, head and ears, acupuncture assists the body’s ability to balance yin and yang of organs by carrying blood to the face to support the “facelift,” and the skin becomes “plumped up” without side effects. Meanwhile, acupuncture corrects the bodies discomfort and illness, such as stress, disturbed sleeping, etc. It goes into the root of ageing not only by benefitting the skin but also slowing down the ageing process.

What is the advantage of an acupuncture face lift vs. a surgical one?

Acupuncture is not a replacement for a surgical facelift or botox injections. Acupuncture will not provide an overnight solution; the improvement is subtle and occurs over time. However, acupuncture face-lifts can be an excellent holistic alternative to a traditional surgical face-lift. With acupuncture, the underlying causes of aging are treated rather than masking the symptoms with a surgical face-lift and allowing further decay and dysfunction to continue within the body.

Treatment with herbs and acupuncture is not only substantially less expensive than a traditional surgical face-lift, but much safer. The treatment is risk free from potential dangerous side effects such as numbness, scarring, swelling, discoloration, and even disfigurement.

What are some of the advantages of acupuncture over botox?

Botox is a neurotoxin and among one of the deadliest known to man. Although it is diluted to control its potency, with frequent use, it is possible for systemic toxicity resulting from accidental injection. However, when used safely and supervised by a physician, botox may be an effective treatment for wrinkles. But not withstanding, acupuncture is safer and less expensive when compared to botox treatments.

 

Michelle’s symptoms are very common among the middle age women approaching menopause with various complaints of body discomforts, wrinkles, dryness, and dark spots on the skin.  Acupuncture and Chinese herbs not only treat the root of skin aging, but also make the patient feel good.

By taking her pulse and collecting all the info including her diet, appetite, sleep, daily activity, digestion, urinary and bowel movement, and observing her tongue, Michelle was diagnosed of deficiency of Liver blood and kidney Qi, stagnation of Liver Qi and Blood, therefore, we took the following steps to help her.

Treatment principle: reinforce kidney essence, nourish liver blood, and remove liver qi/blood stagnation, promote meridian circulation, tone the facial muscles.

  1. Acu-points:  distant point: Live 3, GB42, Sp6, K3, St36, Li11, Li 4, Lu 7, etc.

Fig 2-3

2. Local points: Cv23, 24, du 26, st 9, st 1,2,3,4. GB 1, GB9, Ying tang, dermal needle around wrinkle, line and dark spot, etc.

 

Fig 2-4

3. Ear point: shen men, sympathetic, liver, kidney, lung, etc.

Fig 2-5 4. Facial Guasha: by using a flat tool to slowly rub the face in order to reduce the wrinkles and increase the blood supply to the area.

Fig 2-6

 

5. Acupressure with rosehip/vitamin E oil followed by acupuncture treatment

Fig 2-7

 

Acupuncture: 30 minutes, once or twice per week, 12 sessions in six or eight weeks.  Monthly maintenance after is suggested.

Herbs formula: once a day for at least three months.

  1. Daily suggestion:

1. Drink at least 6-8 glasses of water helps in detoxifying the body.
2. Keep a check on tea/coffee intake
3. Take coconut water daily. It replenishes the skin and fights hyperpigmentation.
4. Add antioxidant Vit.C and Vit.B complex supplements to your diet.
5. Use a homemade pack with curd/ lemon juice/ tamarind paste/ papaya pulp/pineapple juice. It helps to lighten the complexion.

6. Use sun screen spf15 above to prevent excessive sun exposures.

7. Use warm water to wash the face. Avoid using hot water that dries the skin.

8. Moisturize your face, neck and hands morning and before the bed time by add rosehip/Vit.E oil following by facial acupressure so that the skin does not dry but keeps supple.

9. Avoid facial exercises and consciously avoid using facial gestures. Keep the face relaxed as much as possible.

10. No smoking.

After three months of treatment, her skin became more delicate and fair, and there are fewer wrinkles, less sagginess, and a clearing of aging spots. As an added bonus, she says, there is an overall “rejuvenation” that she felt in her body.

 

Fig 2-8

Topical Treatments (For your information)

There are many ingredients that are believed to reduce sun damage, increase collagen production and exfoliate the skin. You can get many products that are enriched with ingredients such as

Topical medicines and creams can be effective in reducing the appearance of wrinkles. Creams that contain alpha-hydroxy acids can make small improvements in the skin. However, they can cause very mild irritation. Retin-A, also known as retinoic acid, is more effective at reducing fine lines, but it must be used for several months. It can also make your skin red and more sensitive to the sun. You should talk to your doctor about the proper use of these ingredients.

If you are interested in acupuncture facial rejuvenation,  please call our office at 203-637-7720 to make an appointment. Thank you!

 

 

 

 

 

 

 

49. Acupuncture and Post-Treatment Lyme Disease Syndrome

Jan 25, 2013   //   by drxuacupuncture   //   Blog, Case Discussions, Uncategorized  //  No Comments

News Letter, Vol. 5 (1), January , 2013, © Copyright

 

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

Robert Blizzard III, DPT

www.drxuacupuncture.co

Rehabilitation Medicine and Acupuncture Center

1171 East Putnam Avenue, Building 1, 2nd Floor

Greenwich, CT 06878

Tel: (203) 637-7720

Fax: (203)637-2693

 

Post-Treatment Lyme Disease Syndrome

My dear friends,

Before you read my case discussion, please read the following ,

I was the president of American Traditional Chinese Medicine Society  (www. http://atcms.org)  between March 2010 and March, 2012. Now, I am honorary  president of ATCMS.  On behalf of ATCMS,  I advise you sign the petition to  urge Obama Administration recognize acupuncturist  as  healthcare providers  and allow Medicare to pay acupuncture treatment.

Thank you for your support! Please sign the petition now!

Jun Xu, MD

Recognize Acupuncturist as Healthcare providers

Despite overwhelming evidence of the positive impact acupuncturist have on patient health, they are not recognized as healthcare providers under the Social Security Act and, therefore, cannot be paid by Medicare for therapy management.

Please visit the website at: https://petitions.whitehouse.gov/petition/recognize-acupuncturist-healthcare-providers/NTNpVFnp, and sign this petition to urge President to recognize acupuncturists as Medicare providers. We do need at least 25000 signatures by February 10, 2013, in order to get a response from the White House. Please forward this email to your family members, friends, and patients, and ask them to do so. Your participation will make a difference.

Thanks for your efforts and participating!

American TCM Society (ATCMS)

 

Fig 1-1

 

Janet, a 36 year old woman, came to me with complaints of body aches and multiple joint pain for the past 6 months.  Janet reported, “Every inch of my body is achy, I am depressed.” She reports having a tick bite about ten months ago, while she was playing with her son in the backyard of her house.  A dead tick was found on her neck close to her hair line with a bull’s  eye rash prompting her to see her physician immediately and receiving antibiotics (doxycycline) for three weeks. She felt fine at that time. However, after one month, she started to develop some flu like symptoms; feeling fatigue, poor sleep, stomach cramps and poor appetite. She took advil for 2 weeks without any improvement. She also felt poor concentration along with severe headaches. Later she developed bilateral knee joint swelling, difficulty walking, a tingling like snake sensation at both legs and hands. She went to many different doctors for her symptoms, though no one could give her a definite answer and treatment, therefore, she came to me for help.

Janet is most likely to have Post-Treatment Lyme Disease Syndrome

Approximately 10 to 20% of patients treated for Lyme disease with a recommended 2–4 week course of antibiotics will have lingering symptoms of fatigue, pain, or joint and muscle aches. In some cases, these can last for more than 6 months. Sometimes it is called “chronic Lyme disease,” this condition is properly known as “Post-treatment Lyme Disease Syndrome” (PTLDS).

The main symptoms of PTLDS are listed as following,

  • Arthritis. After several weeks of being infected with Lyme disease, approximately 60% of those people not treated with antibiotics develop recurrent attacks of painful and swollen joints that last anywhere from a few days to a few months. The arthritis can shift from one joint to another; the knee is most commonly affected and usually one or a few joints are affected at any given time. About 10% to 20% of treated patients will go on to develop lasting arthritis. The knuckle joints of the hands are only very rarely affected.
  • Neurological symptoms. Lyme disease can also affect the nervous system, causing symptoms such as stiff neck and severe headache (meningitis), temporary paralysis of facial muscles (Bell’s palsy), numbness, pain or weakness in the limbs, or poor coordination. More subtle changes such as memory loss, difficulty with concentration, and a change in mood or sleeping habits have also been associated with Lyme disease. People with these latter symptoms alone usually don’t have Lyme disease as their cause.

Nervous system abnormalities usually develop several weeks, months, or even years following an untreated infection. These symptoms often last for weeks or months and may recur. These features of Lyme disease usually start to resolve even before antibiotics are started. Patients with neurologic disease usually have a total return to normal function.

  • Heart problems. Fewer than one out of 10 Lyme disease patients develops heart problems, such as an irregular, slow heartbeat, which can be signaled by dizziness or shortness of breath. These symptoms rarely last more than a few days or weeks. Such heart abnormalities generally appear several weeks after infection, and usually begin to resolve even before treatment.
  • Other symptoms. Less commonly, Lyme disease can result in eye inflammation and severe fatigue, although none of these problems is likely to appear without other Lyme disease symptoms being present.

 

The exact cause of PTLDS is not yet known. Most medical experts believe that the lingering symptoms are the result of residual damage to tissues and the immune system that occurred during the infection. Similar complications and “auto–immune” responses are known to occur following other infections, including Campylobacter (Guillain-Barre syndrome), Chlamydia (Reiter’s syndrome), and Strep throat (rheumatic heart disease). In contrast, some health care providers tell patients that these symptoms reflect persistent infection with Borrelia burgdorferi. Recent animal studies have given rise to questions that require further research, and clinical studies to determine the cause of PTLDS in humans are ongoing.

Regardless of the cause of PTLDS, studies have not shown that patients who received prolonged courses of antibiotics do better in the long run than patients treated with placebo. Furthermore, long-term antibiotic treatment for Lyme disease has been associated with serious complications. The good news is that patients with PTLDS almost always get better with time; the bad news is that it can take months to feel completely well.

If you have been treated for Lyme disease and still feel unwell, see your doctor to discuss how to relieve your suffering. Your doctor may want to treat you in ways similar to patients who have fibromyalgia or chronic fatigue syndrome. This does not mean that your doctor is dismissing your pain or saying that you have these conditions. It simply means that the doctor is trying to help you cope with your symptoms using the best tools available.

It is normal to feel overwhelmed by your ongoing symptoms. Some things that may help you manage your PTLDS include:

  • Check with your doctor to make sure that Lyme disease is not the only thing affecting your health.
  • Become well-informed. There is a lot of inaccurate information available, especially on the internet. Learn how to sort through this maze.
  • Track your symptoms. It can be helpful to keep a diary of your symptoms, sleep patterns, diet, and exercise to see how these influence your well being.
  • Maintain a healthy diet and get plenty of rest.
  • Share your feelings. If your family and friends can’t provide the support you need, talk with a counselor who can help you find ways of managing your life during this difficult time. As with any illness, Lyme disease can affect you and your loved ones. It doesn’t mean that your symptoms are not real. It means that you are a human being who needs extra support in a time of need.
  • Being strong mind, if you know the mechanism of your illness and have strong mind to fight this illness, you will finally get out of the control of the disease.

It is important to note that people with a history of Lyme disease have more musculoskeletal impairments when compared to those without a history of the disease.  Physical Therapy is very effective at treating musculoskeletal impairments such as pain and muscle spasms though multiple means of massage, heat, ultrasound, electrical stimulation.  Muscle weakness and limited endurance are other symptoms that can be greatly improved with treatment.

A common impairment is decreased standing balance and impaired gait pattern that a routine of lower body strengthening, core training and balance exercises would help to restore.  Functional limitations would include difficulty with stair negotiation; sit to stand transfers and the inability to continue to work.  It is important not to over stress yourself with exercise or daily activities to prevent from exacerbating your PTLDS

A few exercises would be a light general warm-up that is easy on the knees being the exercise bike at low-moderate intensity taking breaks as needed.

 

Fig 1-2 http://visionfitness.mercola.com/exercise-bikes.aspx

After warmed-up, a whole body exercise that also works on a common ailment of decreased transfer ability with sit to stands would be chair squats.  With this exercise it is important not to allow your knees to track beyond your toes and to barely allow the hips to touch the seat before standing back up again.  Start with 10 pain free reps and working up to 30 reps total.

 

 

Fig 1-3 http://holistichealthgurus.com/blog/body/squats-with-chair-facing-the-wall/

 

 

Balance is another ailment that can be worked with exercise.  Start out on a flat surface with eyes open for one minute, once that becomes easy start to challenge yourself by closing your eyes only as long as you are standing in front of a couch or table that you can grab hold of if needed.  Continue to progress by then standing on a foam pad to make the surface uneven or stay on the flat surface and stand on one foot at a time with eyes open and then closed.

Fig 1-4 http://www.acefitness.org/certifiednewsarticle/687/designing-balance-exercise-programs-for-older/

A light stretching routine is encouraged to decrease joint stiffness and improve range of motion.  Shown is a simple stretch that if held for 1 minute on each leg will loosen muscles around the most common effected area with PTLDS being the knees.

Fib 1-5 http://www.livestrong.com/slideshow/558801-finding-the-fitness-30/#slide-2

Acupuncture is an excellent alternative way to treat your symptoms. It has no side effects and can be combined with traditional western medicine to relieve your symptoms. The choice of acupuncture treatment of PTLDS  is as following,

  1. Common used points: Du20 Bai Hui,  GB8 Shuai Gu, UB9 Yu Zhen, Ht7 Shen Men, GB20 Feng Chi, UB15 Xin Shu, UB20 Pi Shu, UB18 Gan Shu, UB23 Shen Shu, St6 Zu San Li, Sp6 San Yin Jiao, Lv3 Tai Cong, UB2 Zan Zhu, Kid3 Tia Xi.
  2. Arthritis: Shoulder: LI 15 Jian Yu, SI 9 Jian Zhen, SJ 14 Jian Liao, SI 10 Nao Shu, SI 11 Tian Zhong, LI 16 Ju Gu  Wrist: LI5 Yang Xi and SJ 4 Yang Chi.    Knee: LI 4 He Gu, LI 11 Quchi, St 35 Du Bi, Nei Xi Yan, Sp 10 Xue Hai, St 34 Liang Qiu, He Ding, UB 40 Wei Zhong,  ,
  3. Neurological Symptoms: Fatigue, Depression and Poor Sleep: Major points: St 36 Zu San Li, PC6 Nei Guan,  LI4 He Gu, Ht7 Shen Meng, Sp6 San Yin Jiao, GB20 Feng Chi, Du20 Bai Hui, EX-HN1 Si Shen Cong, assistant points: Du14 Da zhui, Ren12 Zhong Wan, Ren14  Ju Que, Ren6 Qi Hai, Ren4 Guang Yuan, UB21 Wei Shu and UB23 Shen Shu.
  4. Bell’s Palsy: GB14 Yang Bai penetrating  Ex Yu Yao, and Si Bai, Tai Yang  penetrating  St7 Xia Guan, St4 Di Chang penetrating  St6 Jia Che, LI20 Ying Xiang, UB2 Zan Zhu, Ren24 Cheng Jiang.
  5. Heart Palpitation: PC6 Nei Guan, Ht7 Shen Men, UB15 Xin Shu, Ren14 Ju Que, UB14 Jue Yin Shu
  6. Dizziness: Si Shen Chong, Du20 Bai Hui, Du12 Shen Zhu, UB12 Feng Men, UB43 Gao Huang, Sp6 San Yin Jiao, St36 Zhu San Li, LI11 Qu Chi.

Janet’s Treatment:

Janet was treated with me for 2 x per week for 8 weeks. I first try to decrease her pain at the joints and body with the points of group 1 and 2 , then, I used the group 3 points to help her to improve her fatigue and depression, after about 2 month’s treatment, Janet felt much improved. Her pain scale decreased from 9/10 to 2/10. She then had maintenance treatment for once a week for another 2 weeks, she finally discharged without pain.

Tips for Patients:

  1. Early diagnosis and early treatment: Always suspect you might have Lyme disease if you have exposed to wild environment with skin rash. Early treatment is the key to reduce the rate of  Post Treatment of Lyme Disease Syndrome.
  2. Multiple Therapy is the best way to treat PTLDS.  Anti-inflammatory Medication, Physical Therapy and Acupuncture Treatment together will help you a lot.

Tips for Acupuncturists:

  1. Treat your patients as a whole person, you not only treat their pain symptom, but also their stress, fatigue, and depression. To relieve the mental stress is the key for the effects of your acupuncture treatment.
  2. Encourage your patients to have at least 8 weeks treatment. It is very important to have a long term treatment to achieve the best results.

 

 

References

Reviews of human research

Marques, A. Chronic Lyme disease: a review. Infect Dis Clin North Am 2008; 22:341–60.

Feder, et al. A critical appraisal of “chronic Lyme disease”. New Eng. J. Med. 2008; 357:1422–30.

Non-human research

The following publications refer to studies in mice and monkeys. Please note that while animal studies are helpful, further research is necessary to determine whether these results correlate with human disease.

Barbour A. Remains of infection. J Clin Invest. 2012 Jul 2;122(7):2344–6. doi: 10.1172/JCI63975. Epub 2012 Jun 25.

Bockenstedt LK, Gonzalez DG, Haberman AM, Belperron AA. Spirochete antigens persist near cartilage after murine Lyme borreliosis therapy. J Clin Invest. 2012 Jul 2;122(7):2652–60. doi: 10.1172/JCI58813. Epub 2012 Jun 25.

Embers ME, Barthold SW, Borda JT, Bowers L, Doyle L, et al. (2012) Persistence of Borrelia burgdorferi in Rhesus macaques following antibiotic treatment of disseminated infection. PLoS ONE 7(1): e29914.

Reference resource:

http://www.webmd.com/rheumatoid-arthritis/arthritis-lyme-disease 

http://www.cdc.gov/lyme/postLDS/index.html

 

 

48. Acupuncture and Multiple Sclerosis

Dec 22, 2012   //   by drxuacupuncture   //   Blog, Case Discussions, Uncategorized  //  No Comments

News Letter, Vol. 4 (12), December , 2012, © Copyright

 

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

Robert Blizzard III, DPT

www.drxuacupuncture.co

Rehabilitation Medicine and Acupuncture Center

1171 East Putnam Avenue, Building 1, 2nd Floor

Greenwich, CT 06878

Tel: (203) 637-7720

Fax: (203)637-2693

Multiple Sclerosis

                                                                                    americancompanioncare.com

 

 

Jane is a 40 year-old woman who complains of feeling tired and fatigue now for 6 months.  She works as a computer programmer and has two children ages 4 and 6 years old. She never felt fatigue before, as she works 40 hours a week then comes home to take care of her family.  She recently reports heat intolerance and a stumbling gait with a tendency to fall. Two months ago the patient was working very hard and was under a lot of stress. She then got sick with the flu and her neurologic condition worsened. Her visual acuity also seemed to change periodically during several years.  She has had difficulty holding objects in her hands accompanied with significant tremors and severe exhaustion. She also had several bad falls. Since then, she had noticed multiple areas of joint pain on the right and subsequently on the left side of her body. Then, the patient abruptly developed a right side half body sensory deficit after several days of work.

She visited her Neurologist, who ordered a MRI scan which revealed a multifocal white matter  in both cerebral hemispheres. Spinal tap was also done which showed the presence of oligoclonal bands in Cerebral Spinal Fluid. Visual evoked response testing was abnormal with slowed conduction in optic nerves.

This patient is most likely to have Multiple Sclerosis. This disease occurs more often in women between ages of 20-40.  MS is caused by damage to the myelin in the central nervous system, and to the nerve fibers, which interferes with the transmission of nerve signals between the brain, spinal cord and other parts of the body. Depending on the location of the pathology, patients reveal the following symptoms.

Most Common Symptoms

Some symptoms of MS are much more common than others.

Fatigue

Numbness

Walking (Gait), Balance, & Coordination Problems

Bladder Dysfunction

Bowel Dysfunction

Vision Problems

Dizziness and Vertigo

Sexual Dysfunction

Pain

Cognitive Dysfunction

Emotional Changes

Depression

Spasticity

Less Common Symptoms
These symptoms also occur in MS, but much less frequently.

Speech Disorders

Swallowing Problems

Headache

Hearing Loss

Seizures

Tremor

Respiration / Breathing Problems

Itching

The Criteria for a Diagnosis of MS

In order to make a diagnosis of MS, the physician must:

  • Find evidence of damage in at least two separate areas of the central nervous system (CNS), which includes the brain, spinal cord and optic nerves AND
  • Find evidence that the damage occurred at least one month apart AND
  • Rule out all other possible diagnoses

In 2001, the International Panel on the Diagnosis of Multiple Sclerosis updated the criteria to include specific guidelines for using magnetic resonance imaging (MRI), visual evoked potentials (VEP) and cerebrospinal fluid analysis to speed the diagnostic process. These tests can be used to look for a second area of damage in a person who has experienced only one attack (also called a relapse or an exacerbation) of MS-like symptoms — referred to as a clinically-isolated syndrome (CIS). A person with CIS may or may not go on to develop MS.

The criteria  (now referred to as The Revised McDonald Criteria) were further revised in 2005 and again in 2010 to make the process even easier and more efficient. (http://onlinelibrary.wiley.com/doi/10.1002/ana.22366/full)

Treatment

There is no known cure for multiple sclerosis at this time. However, there are therapies that may slow the disease. The goal of treatment is to control symptoms and help you maintain a normal quality of life.

Medications used to slow the progression of multiple sclerosis are taken on a long-term basis, they include:

  • Interferons (Avonex, Betaseron, or Rebif), glatiramer acetate (Copaxone), mitoxantrone (Novantrone), and natalizumab (Tysabri)
  • Fingolimod (Gilenya )
  • Methotrexate, azathioprine (Imuran), intravenous immunoglobulin (IVIg) and cyclophosphamide (Cytoxan) may also be used if the above drugs are not working well

Steroids may be used to decrease the severity of attacks.

Medications to control symptoms may include:

  • Medicines to reduce muscle spasms such as Lioresal (Baclofen), tizanidine (Zanaflex), or a benzodiazepine
  • Cholinergic medications to reduce urinary problems
  • Antidepressants for mood or behavior symptoms
  • Amantadine for fatigue

The following may also be helpful for people with MS:

  • Physical therapy, speech therapy, occupational therapy, and support groups
  • Assistive devices, such as wheelchairs, bed lifts, shower chairs, walkers, and wall bars
  • A planned exercise program early in the course of the disorder
  • A healthy lifestyle, with good nutrition and enough rest and relaxation
  • Avoiding fatigue, stress, temperature extremes, and illness
  • Changes in what you eat or drink if there are swallowing problems
  • Making changes around the home to prevent falls

At some stage during the course of MS, over 75% of people report problems with balance.  In addition to issues with balance is the prevalence of falls which is reported to be over 50%.

 

Evidence suggests that balance may be positively improved by:

Individual physiotherapy using facilitation and functional activities

Group exercise classes, primarily by way of a functional based framework

Home balance training interventions

Targeted force-platform balance tasks

(Balance for people with multiple sclerosis. ISBN: 978-0-9806637-2-3. MS Australia June 2009)

 

 

 

 

http://www.acefitness.org/certifiednewsarticle/687/designing-balance-exercise-programs-for-older/

 

It is critical to prevent overheating while exercising or performing daily activities as this will cause MS symptoms to become much worse.  Taking numerous breaks with exercise, breaking daily chores down into smaller steps and avoiding hot and humid weather are a few steps to take.  A cool water swimming pool is a great way to seek a fitness routine or finding a gym with air conditioner during the hotter months of the year.  Again heat and humidity will cause nerve transmission to become slower and make symptoms intensify until body temperature returns and all of this can occur in just a half degree raise in body temperature.

 

Acupuncture treatment for MS:

Acupuncture can not cure MS, however, acupuncture treatment may significantly improve patient’s symptom, the following methods could be used to help MS patients.

  1. Common used points: Du20 Bai Hui, GB7 Qu Bing, GB8 Shuai Gu, UB9 Yu Zhen, Ht7 Shen Men, GB20 Feng Chi, UB15 Xin Shu, UB20 Pi Shu, UB18 Gan Shu, UB23 Shen Shu, UB32 Chi Liao, GB30 Huan Tiao, Sp6 San Yin Jiao, Lv3 Tai Cong, UB2 Zan Zhu, Kid3 Tia Xi.
  2. Fatigue and depression: Major points: St 36 Zu San Li, PC6 Nei Guan, LI4 He Gu, Ht7 Shen Meng, Sp6 San Yin Jiao, GB20 Feng Chi, Du20 Bai Hui, EX-HN1 Si Shen Cong, assistant points: Du14 Da zhui, Ren12 Zhong Wan, Ren14  Ju Que, Ren6 Qi Hai, Ren4 Guang Yuan, UB21 Wei Shu and UB23 Shen Shu.
  3. Weakness in the upper extremities: LI15 Jian Yu, LI11 Qu Chi, LI10 Shou San Li, SJ5 Wai Guan, LI4 He Gu
  4. Weakness in the lower extremities: GB30 Huan Tiao, St31 Bi Guan, GB31 Feng Shi, St36 Zu San Li, GB34 Yang Ling Quan, Sp6 San Yin Jiao, GB39 Xuan Zhong, UB60 Kun Lun.
  5. Speech difficulty: Ren23 Lian Quan, LI4 He Gu, Ht5 Tong Li, Du15 Ya Meng,
  6. Swallow difficulty: Ren22 Tian Tu, Ren23 Lian Quan, LI18 Hu Tu, GB20 Feng Chi, LI4 He Gu
  7. Bladder Dysfunction: Ren4 Guan Yuan, Ren6 Qi Hai, Ren3 Zhong Ji, UB23 Shen Shu
  8. Constipation: St36 Zu San Li, GB34 Yang Ling Quan, St25 Tian Shu, UB19 Da Chang Shu, Ren12 Zhong Wan
  9. Vision: UB1 Jing Ming, EX-HN5 Tai Yan, GB37 Guan Ming
  10. Facial Paralysis: SJ17 Yi Feng, St7 Xia Guan, St4 Di Chang, St6 Jia Che

Jane’s Treatment:

Jane’s main complaints are fatigue and weakness with visional difficulty. I choose the first and second groups of the points, plus Jing Ming, Tai Yan, Guang Ming. She received my treatment 3 x per week for 4 weeks, she felt her energy level was much better. She also was told not to be exposed to heat, because heat usually exacerbated fatigue and weakness. Her symptoms were getting better, she then kept her treatment once a week for maintenance. Her quality of life now is much improved.

 

Tips for Acupuncturists:

  1. St36 Zu San Li, Sp6 San Yin Jiao, LI4 He Gu and LI11 Qu Chi are most important points to improve energy and decrease fatigue for MS patients.
  2. Du20 Bai Hui and EX-HN1 Si sheng Cong can greatly decrease patients’ depression and improve energy.

Tips for Patients:

1, Massage Zu San Li 10 min x 2 to 3 per day will improve your energy level.

2.  Avoid over heat, the more heat you exposed, the more fatigue and depression you will         have.

 

47. Acupuncture and Tinnitus

Nov 25, 2012   //   by drxuacupuncture   //   Blog, Case Discussions, Uncategorized  //  No Comments

­ News Letter, Vol. 4 (11), November , 2012, © Copyright

 

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

Robert Blizzard III, DPT

www.drxuacupuncture.co

Rehabilitation Medicine and Acupuncture Center

1171 East Putnam Avenue, Building 1, 2nd Floor

Greenwich, CT 06878

Tel: (203) 637-7720

Fax: (203)637-2693

Tinnitus

www.reviews4you.net

Tinnitus

John, a sixty-seven-year-old man, recently retired from teaching high school, then went back to work as a security guard at the school gate. Whenever he begins to read, he starts to experiences sound within his ear, though there is no corresponding external sound. The off-and-on sound can be a strong ringing noise in his right ear, a high-pitched whining noise, buzzing, or hissing. If he pays attention to something else, he does not experience the tinnitus, but if he is idle or preparing to go to sleep, the sound recurs and can interfere with his ability to either concentrate or hear, which is very frustrating. He consulted several doctors, including an ENT specialist and a neurologist. The ENT doctor checked his outer, middle, and inner ears, and found no infection or allergies, and no edema in the ear. The neurologist ordered a CT scan and an MRI, which did not show a tumor or any problem with the brain. He was prescribed such medications as Xanax and tricyclic antidepressants, as well as niacin, all to no avail. At this point he was referred to me for evaluation.

I determined that John probably had tinnitus, the symptoms of which are hearing phantom sounds in the ear, including buzzing, clicking, hissing, ringing, or whistling, when there is no external noise. The sounds may vary in pitch from a low roar to a high squeal, and the person may hear it in one or both ears. The sound is sometimes continuous, sometimes intermittent, and it may interfere with the ability to concentrate. When the person is nervous or experiences stress, the tinnitus becomes worse.

Types of Tinnitus

There are two types of tinnitus.

  • Subjective tinnitus is the most common form, and only the person can hear or feel it in this type. About one fifth of the population complains of this kind of tinnitus, which can be caused by ear problems in the outer, middle, or inner ear. It can also be caused by problems with the auditory nerves or the brain stem, which can interrupt the nerve signals as sound.
  • Objective tinnitus is the type where both the patient and the doctor doing the examination can feel the sound. This is the rare type of the condition. It can be a muscular issue, or it can be caused by blood vessel or inner-ear bone problems.

 

Causes of Tinnitus

There are many causes of tinnitus, but the most common is hearing loss. As people age, they lose hearing because of tremors to the ear through noise, drugs, or chemicals, which damage the portion of the ear that allows them to hear. Examples include acoustic shock, external ear infection, ear-wax impaction, lead or mercury poisoning, Menière’s disease, or such toxic medications as aspirin, erythromycin, or tetracycline. There are also neurological disorders, such as head injuries, psychiatric disorders, such as depression and anxiety, sclerosis, or metabolic disorders, such as thyroid problems, hyperlipidemia, and vitamin B12 deficiency.

A common cause of tinnitus is inner ear cell damage. Tiny, delicate hairs in your inner ear move in relation to the pressure of sound waves. This triggers ear cells to release an electrical signal through a nerve from your ear (auditory nerve) to your brain. Your brain interprets these signals as sound. If the hairs inside your inner ear are bent or broken, they can “leak” random electrical impulses to your brain, causing tinnitus.

 

http://www.riversideonline.com

 

www. naturalypure.com

The above depicts the organ of corti of inner ear, there are about 15,000 micorscopic sensory hair cells, which are very fragile and easily damaged. The hair cells detect any tiny movement of the body in any direction,  after activation of the hair cells by the wave of the body movement,  the hair cells send signals to the underlining tectorial membrane generating an electrical impulse which the brian interprets as sound.  If the hair cells  constant send out the signals after damage,  the patients usually feel contant noise, called tinnutis.

 

Treatments in Western Medicine

Objective Tinnitus

For this type of tinnitus, the obvious cause needs to be treated. If there is an acoustic tumor or an infection, the tumor should be removed, or the infection alleviated. These might make the tinnitus disappear or decrease in intensity. While there are many different treatments for tinnitus, none has proven to be entirely reliable. Western medicine treats this condition with gamma knife radiosurgery, cochlear implants, Botox, or medications, such as propanol and clonazepam.

Subjective Tinnitus

For this type of tinnitus, the treatment might be lidocaine injections to the inner ear, and benzodiazepine to calm the person and decrease his or her anxiety, tricyclic antidepressants to decrease depression, or carbamazepine and melatonin to help decrease the tinnitus. None of these treatments show any statistical difference in the cure of tinnitus. Other methods include electrical stimulation, such as transcranial direct current stimulation, or direct stimulation to the auditory cortex by implanting electrodes.

 

Treatments in Traditional Chinese Medicine

Traditional Chinese medicine believes there are two main causes for tinnitus.

  • Excessive fire attack is one cause. The gallbladder meridians go up to the top of the head and around the ear; if there is excessive heat, this will go through the ear and cause blockage of energy, so the meridians cannot transmit normal sound to the inner ear. This type of tinnitus is high pitched, usually accompanied by anxiety, headaches, and sometimes fear, dry mouth, constipation, yellowish urine, and red face; sometimes the chest feels uncomfortable and painful, with red tongue body and yellow tongue coating. The treatments mostly used are SJ 5 Wai Guan, SJ 17 Yi Feng, SI 19 Ting Gong, SJ 21 Er Meng, UB 18 Gan Shu, and Liv 3 Tai Chong.
  • Yin deficiency syndrome. The person feels weak and has a pale face, and the tinnitus is slow and low in pitch; sometimes it is off and on, with the pitch sound decreasing when the person holds her or his breath. This form of tinnitus is often accompanied by dizziness, faintness, shortness of breath, tiredness, and weakness of the legs; sometimes there is a low-grade fever, the palms are hot, there is no taste in the mouth, with a very thin coating on the tongue and a weak pulse. This type belongs to a yin deficiency and the treatment should be to tonify the yin and enhance the kidney. The acupuncture points are UB 23 Sheng Shu, Kid 4 Tai Xi, SJ 17 Yi Feng, SJ 21 Er Meng, SI 19 Ting Gong, GB 2 Ting Hui, SJ 5 Wai Guan, and UB 18 Gan Shu.
  • The most important points are as following.

 

John’s Treatment

John underwent TCM treatment for reducing excessive heat with SI 19 Ting Gong and GB 2 Ting Hui points on both sides, and Liv 3 Tai Chong and St 36 Zu San Li, all of which were utilized to decrease excessive heat in the kidney and to improve his kidney and stomach function. After one month, John reported that he began to experience a decrease in the pitch of the tinnitus, and after two months, he reported that he heard no sounds about 70 percent of the time. He was advised to do some exercises and learn to deal with stress, and after three months of treatment his condition was much improved.

In my personal experience, the Ting Gong, Ting Hui, and Er Meng are the most important points, and by using this acupuncture treatment plus electrical stimulation each session for 30 minutes three times a week for one to two months, the tinnitus symptoms will most likely greatly decrease.

 

Tips for Acupuncturists and Patients

  • Always massage points SJ 21, SI 19, and GB 2 for 30 minutes each session, 2 sessions per day. Acupressure the points with your thumb or knuckle, pressing with comfortable pressure on the points. You should work symmetric points at the same time.
  • Try to avoid loud sounds.

 

46. Acupuncture and Fibromyalgia

Oct 25, 2012   //   by drxuacupuncture   //   Blog, Case Discussions, Uncategorized  //  No Comments

News Letter, Vol. 4 (10), October, 2012, © Copyright

 

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

Robert Blizzard III, DPT

www.drxuacupuncture.co

Rehabilitation Medicine and Acupuncture Center

1171 East Putnam Avenue, Building 1, 2nd Floor

Greenwich, CT 06878

Tel: (203) 637-7720

Fax: (203)637-2693

Fibromyalgia

Helen is a 46 years old female, who complains of pain all over the body for about one year. Her husband lost his job about one year ago and has tried his best to find one.  However, he has had no such luck. Helen started to worry about her family financial situation and very often could not sleep well. She always feels sluggish as sleep is not replenishing her energy. She wake up feeling very stressed out and moody and worrying about everything.  She gradually developed pain all over the body, feeling tenderness at symmetric points, such as neck, upper back, shoulders, elbows, middle back, low back, hip, knee and calf. The pain is getting worse, now even moderate touch could make her feel pain. She was forced to move out of her house because she was unable to pay her mortgage and moved in an apartment recently. This made her symptom worse,  she went to her primary care physician, who checked her blood work, chest x-ray and EKG, all were normal, and  prescribed Ambien and pain medication, such as Oxycodone, she felt temporarily  relief, however, she had constipation, headache, sometimes diarrhea, felt very tired when waking up. Because the symptoms were getting worse, therefore, she came to me for evaluation  and treatment.

Upon examination, she looked very tired and fatigue, spoke with a low tone, she was found to have many tender points along the spine, chest ribs, shoulders, elbows, hips and knees, when she was touched by my fingers.

This patient might have fibromyalgia, a common syndrome, most often occurring in middle age women.  Symptoms are long-term, body-wide aches, pains and tenderness.  Typically symmetric in the joints, muscles, tendons, and other soft tissues, very often with accompanying fatigue, depression, insomnia, and anxiety.

Causes

The cause is unknown. Possible causes or triggers of fibromyalgia include:

  1. Genetics: the mode of inheritance is currently unknown, but it is common to see patients in one family, especially mother and daughter.
  2. Stress: an important precipitating factor, Fibromyalgia is frequently found with stress-related disorders, such as chronic fatigue syndrome, posttraumatic stress syndrome, irritable bowel syndrome, and depression.
  3. Physical or emotional trauma
  4. Poor sleep.

Among the above possible causes, the most important are stress and poor sleep,   stress and poor sleep make a noxious cycle: Stress causes poor sleep, poor sleep enhances stress, both stress and poor sleep make muscles unable to relax, for a long time period, the muscles nerve get chance to relax, then it twists together and forms the tender points and bends, which are symmetric and long term.

Fibromyalgia is most common among women aged 20 to 50.

Symptoms-Pain

Widespread pain, fatigue, and severe pan in response to light pressure, numbness and tingling sensation, muscle spasm and weakness in all 4 extremities, nerve pain, muscle taut band, twitching, chronic sleep disturbances, and irritable bowel syndrome.

Fibromyalgia patients tend to wake up with body aches and stiffness, pain improves during the day and gets worse at night. Some patients have pain all day long. Pain may get worse with activity, cold or damp weather, anxiety, and stress.

Fatigue, depressed mood, and sleep problems are seen in almost all patients with fibromyalgia. Many say that they can’t get to sleep or stay asleep, and they feel tired and stiffness when they wake up.

Many patients experience impaired concentration, poor memory, inability to multi-task, poor attention span, anxiety and depression.

The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia New Diagnostic Criteria and measurement of symptom severity.

Arthritis Care Res (Hoboken). 2010 May;62(5):600-10.

The new criteria keep the requirements that other causes be ruled out and that symptoms have to have persisted for at least 3 months.  They also includes 2 new methods of assessment, the widespread pain index (WPI) and the symptom severity (SS) scale score.

The WPI lists 19 areas of the body and you say where you’ve had pain in the last week.  You get 1 point for each area, so the score is 0-19.

                                                                         http://www.home-health-care-physical-therapy.com/Fibromyalgia-Tender-Points.html

For the SS scale score, the patient ranks specific symptoms on a scale of 0-3.  These symptoms include:

  • Fatigue
  • Waking unrefreshed
  • Cognitive symptoms
  • Somatic (physical) symptoms in general (such as headache, weakness, bowel problems, nausea, dizziness, numbness/tingling, hair loss)

The numbers assigned to each are added up, for a total of 0-12.

This next part is really interesting to me.  Instead of looking for a hard score on each, there’s some flexibility built in, which recognizes the fact that fibromyalgia impacts us all differently, and that symptoms can fluctuate.

For a diagnosis you need EITHER:

  1. WPI of at least 7 and SS scale score of at least 5, OR
  2. WPI of 3-6 and SS scale score of at least 9.

Treatment

The goal of treatment is to improve impaired function, help a person mentally and physically cope with the symptoms, and to help relieve pain and other symptoms,

The first type of treatment may involve:

  • Physical therapy
  • Exercise and fitness program
  • Stress-relief methods, including light massage and relaxation techniques

Physical Therapy is aimed at treating the disease consequences of fibromyalgia including pain, fatigue, deconditioning, muscle weakness and sleep disturbances among others.

Modalities such as ultrasound and TENS machines will help reduce localized and generalized musculoskeletal pain in fibromyalgia patients.

Massage is great to reduce muscle tension and spasms which prevent efficient muscle motion.  Techniques such a joint mobilizations and deep tissue massage prescribed with other therapeutic interventions such as stretching will help your muscles more effectively.

Physical Therapy consult is very beneficial to address sleeping disturbances affecting about 80% of all patients.  Positioning while sleeping and relaxation techniques prior to sleeping can help correct this serious problem.

Fitness machines such as exercise bikes or elliptical machines will improve important measures of cardiovascular fitness, subjective and objective measures of pain.  Also improving is subjective energy levels, work capacity along with physical and social activities.

Focusing on core stability will reduce overloading of the muscle system by supporting the muscles of your spine.  There is a great impact on conditioning weak muscles for improving postural fatigue and positioning.  With a strong core, your body will have a stable, center point.

There is great evidence based research for Whole Body Vibration use on patients with fibromyalgia.  A 6-week study published in 2008, in The Journal of Alternative and Complementary Medicine, by Alentorn-Geli et al reports that WBV safely reduces pain and fatigue while also improving physical function in patients with fibromyalgia.  Here at Rehab Medicine & Acupuncture Center, we have been using this evidence based device in successfully treating symptoms of fibromyalgia.

Another study looking at the benefits of WBV with fibromyalgia performed by Sanudo et al in 2010 was published in Clinical and Experimental Rheumatology. This study examined women with fibromyalgia performing exercise training 2 times a week along with WBV three days a week compared with an exercise only group over a 6-week period with a focus on strength and quality of life.  Significant improvements in all outcomes measured were found from baseline in both groups though additional health benefits were observed with the supplementary WBV.

The second line of treatment is medications, such as antidepressant or muscle relaxant in order to improve sleep and pain tolerance, Duloxetine (Cymbalta), Pregabalin (Lyrica) and Milnacipran (Savella) are very often prescribed.

However, many other drugs are also used to treat the condition, including:

  • Anti-seizure drugs
  • Other antidepressants
  • Muscle relaxants
  • Pain relievers
  • Sleeping aids

Cognitive-behavioral therapy is an important part of treatment. This therapy helps you learn how to:

  • Deal with negative thoughts
  • Keep a diary of pain and symptoms
  • Recognize what makes your symptoms worse
  • Seek out enjoyable activities
  • Set limits

Acupuncture treatment for Fibromyalgia

Acupuncture points mainly are selected from meridians of Tai Yang and Sao Yang, plus cupping.

UB9 Yuzhen, UB16 Dushu, UB18 Ganshu, UB23 Shenshu, Ren6 Qihai, Du20 Baihui, GB13 Bensheng, GB21Jianjin, GB34 Yanglingquan, LI15 Jianyu, ST 36 Zusanli, Sp8 Diji, Ki8 Jiaoxin, UB59 Fuyang, Arshi, etc.

 

Helen’s Treatment:

Helen underwent our treatment about 3 months. I first helped her improve her sleep. According to Chinese Medicine, the key factor was sleep, if the patient can have better sleep, her noxious cycle will be broken, and along with her improvement of sleep, her muscles was gradually relaxed and her pain was gradually reduced. She also was encouraged to have physical therapy to improve her functional abilities and join the entertainment activities,  she had difficulty playing tennis at beginning, after a few treatments, her performance of tennis was getting better, and after all the treatment for three months,  her pain is almost gone and quality of life is much better.

Tips for patients:

    1. Keep a peaceful mood, and you have to realize that your worrying does not take away your stress, but adds stress to you.
    2. Try to get a good sleep nightly, take hot shower before go to bed and avoid TV in order to have a nice sleep routine.
    3. Massage sleep points 5 mins before you go to bed.
    4. Force yourself  to attend the entertainment activities

Tips for Acupuncturists:

  1. Try to help patients to have good sleep by selecting Baihui, An Mian, etc.
  2. Try to help patients to have stress reduction by selecting Shen Men, Shen Shu, etc.
  3. Encourage patients attend all the activities.
  4. Cupping along UB meridian is very helpful.

 

44. Acupuncture and Irritable Bowel Syndrome-IBS

Aug 26, 2012   //   by drxuacupuncture   //   Blog, Case Discussions, Uncategorized  //  No Comments

News Letter, Vol. 4 (8), Auguse , 2012, © Copyright

 

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

Robert Blizzard III, DPT

www.drxuacupuncture.co

Rehabilitation Medicine and Acupuncture Center

1171 East Putnam Avenue, Building 1, 2nd Floor

Greenwich, CT 06878

Tel: (203) 637-7720

Fax: (203)637-2693

Irritable Bowel Syndrome—IBS

 

 

Irritable Bowel Syndrome (IBS)

Lucy P. is a thirty-two-year-old student who came to me complaining of abdominal pain. She told me the pain is slow to come on. She feels it off and on and it can either be severe or mild. She also feels bloated and gaseous, and has constipation alternating with diarrhea, which produces mucus in the stool and is sometimes worse in the morning.

She generally feels mild depression, is shy and afraid to talk with people, and is unable to find a job. When she lived at home for five years after graduation, her parents encouraged her to go out and find employment, but her lack of communication skills made this impossible, so she decided to go back to school and earn a graduate degree in media communications. With graduation approaching, she began to feel nervous, knowing her parents expected her to get a job immediately after graduation. And she was depressed, experiencing insomnia, stomach aches, abdominal pain, and the bloating and diarrhea that sometimes turned to constipation. She was also vomiting and the pain and diarrhea she was experiencing interrupted her sleep and caused weight loss. She was frustrated with her condition, as were her parents, which is why she sought help from me.

A physical examination showed that Lucy had a soft abdomen, a normal bowel sound, no fever or chills, and a negative stool culture. I also sent her for a colonoscopy, which was negative as well. I determined that Lucy might have irritable bowel syndrome (IBS), a chronic gastrointestinal disorder of unknown cause, whose symptoms include the same abdominal cramping and pain, bloating, gassiness, and alternating bouts of diarrhea and constipation she was experiencing.

Unlike ulcerative colitis or Crohn’s disease, IBS is not an inflammatory intestinal disease. It does not cause inflammation or changes in bowel tissues, and it does not increase the risk of colorectal cancer. In many cases, IBS may be attributed to diet, lifestyle, and stress. It can be very difficult to diagnose because IBS is a diagnosis of exclusion. A CT scan and laparotomy study may be needed, even a colonoscopy, to first rule out cancer, gastritis, peptic ulcer, or the like. After all these diseases have been eliminated, it is then possible to make a diagnosis of IBS—irritable bowel syndrome.

 

Treatments in Western Medicine

People with irritable bowel syndrome should temporarily avoid all dairy products in order to rule out lactose intolerance, which sometimes mimics IBS. It is also necessary to avoid certain foods, such as the cruciferous vegetables—broccoli, Brussels sprouts, cabbage, and cauliflower—and beans as these can increase the bloating and gassiness. It may also help to increase the intake of fibers and try to decrease stress. If necessary, the doctor may prescribe antidepressant or antispasmodic medications, such as Bemote, Bentyl, and Lesin, or anti-diarrhea medication, such as Imodium. There are also some new medications that can probably help, such as tegaserod (brand name Zelnorm), used for the short-term treatment of IBS when constipation is the main symptom, and Lotronex, used for severe, chronic, diarrhea-predominant IBS. This latter drug may, however, cause many undesirable side effects, including death in men, so this treatment is approved only for women—and then, as for all pharmaceutical drugs, with caution.

 

Treatments in Traditional Chinese Medicine

The abdominal pain of this disorder is associated with the development of external disease and internal deficiency.Three types are associated with this condition.

  • Type 1 is excessive coldness. Its main symptom is the abdominal pain, which becomes worse when the person drinks cold water. Also when the abdomen is exposed to cold in both the upper and lower extremities, that leads to low energy. In this case, the large intestine has no pushing force and and that triggers constipation; the person does not feel thirsty, however, and has long, cold urination. The principle of the treatment is to warm up the intestine and decrease the pain. The acupuncture points used are Ren 12 Zhong Wan, Ren 4 Guan Yuan, St 36 Zu San Li, and Sp 4 Gong Sun. The latter two can help decrease the coldness and improve the stomach movement, and St 36 and Sp 4 decrease the stomach ache and improve the spleen and stomach function.

                                                                      Table 8-1

 

  Points Meridian Number Conditions Helped
1 Zhong Wan Ren 12

 

Stomach pain, abdominal distention, nausea, vomiting. GERD, diarrhea, dysentery,

 

2 Guan Yuan Ren 4

 

Enuresis, nocturnal emission, frequency of urination, diarrhea, abdominal pain, etc
3 Zu San Li St 36

 

See Table 13.3
4 Gong Sun Sp 4

 

See Table 18.1

Please refer to the accompanying Figures (illustrations) for the

locations of the points. And please note that these illustrations are

for information only and may not show all the exact locations of

the acupuncture points.

 

Figure 8.1

 

 

Fig 8.2

 

  • Type 2 is excessive hotness of the abdomen. This manifests itself in bloating, and in hardness and tenderness of the abdomen. The person craves cold water, becomes constipated, and experiences short, hot urination, and yellowish and dry coating of the tongue. The treatment for this condition is to eliminate the heat and treat the constipation. The acupuncture points are UB 25 Da Chang Shu, UB 24 Qi Hai Shu, St 37 Shang Ju Xu, LI 4 He Gu, LI 11 Qui Qi, St 44 Nei Ting, UB 24 and 25, and they are all very effective points to help bowel movements. LI 4 and LI 11 enhance the effectiveness of the rest of the points to improve bowel movements, so all these points together will increase pushing energy in the large intestine.

Figure 8.3

 

Table 8.2

  Points Meridian Number Conditions Helped
1 Da Chang Shu UB 25

 

Low back pain, diarrhea, constipation, muscular atrophy, pain, numbness and motor impairment of the lower extremities, sciatica
2 Qi Hai Shu UB 24

 

Low back pain, irregular menstruation, asthma
3 Shang Ju Xu St 37

 

Abdominal pain, diarrhea, dysentery, constipation, paralysis due to a stroke
4 He Gu LI 4

 

See Table 12.1
5 Qu Qi LI 11

 

See Table 12.2
6 Nei Ting St 44

 

See Table 18.1

Please refer to the accompanying Figures (illustrations) for the

locations of the points. And please note that these illustrations are

for information only and may not show all the exact locations of

the acupuncture points.

 

  • Type 3 is excessive activity of the liver qi (energy) causing abdominal pain. The main symptoms are abdominal pain, anxiety, depression, and panic attacks, as well as a pain that radiates to the chest, and shooting pains down the side of the abdomen that feel better after a deep sigh. The pain becomes worse during a panic attack, depression, or periods of anxiety. The principal treatment for this type of IBS is to regulate the liver energy and decrease the abdominal pain, so the acupuncture points used for treatment are Liver UB 18 Gan Shu, Liver 3 Tai Cong, and Liver 14 Qi Meng. Since these points all are related to the liver, they will calm the hyperactivity of the liver energy, and improve the liver’s function of regulating the stomach and the large intestine’s movement and function. St 25 Tian Shu and St 36 Zu San Li are the important points that help make the necessary adjustment to the stomach and large intestine and decrease the diarrhea and constipation. GB 34 Yang Ling Quan and RN 6 Qi Hai improve the energy flow of the abdomen and decrease muscle spasms in the bowels and stomach. Taken together, all these points will help for this type of IBS.

 

Table 8.3

  Points Meridian Number Conditions Helped
1 Gan Shu UB 18

 

Backache, blurred vision, epilepsy, jaundice, mental disorders, night blindness, redness of the eye, spitting blood
2 Tai Cong Li 3

 

See Table 18.1
3 Qi Men Li 14

 

Acid regurgitation, depression, hiccups
4 Tian Shu St 25

 

Abdominal pain, constipation, diarrhea, dysentery, irregular menstruation, swelling
5 Yang Ling Quan GB 34

 

Bitter taste in the mouth, infantile convulsions, jaundice, numbness and pain of the lower extremities, swelling and pain of the knee, weakness, vomiting
6 Zu San Li St 36

 

See Table 13.3
7 Qi Hai RN 6

 

Abdominal pain, nocturnal emission, impotence, hernia, swelling, diarrhea, dysentery, uterine bleeding, irregular menstruation, post-partum hemorrhage, constipation, asthma

Please refer to the accompanying Figures (illustrations) for the

locations of the points. And please note that these illustrations are

for information only and may not show all the exact locations of

the acupuncture points.

 

Figure 8.4

 

Lucy’s Treatment

Lucy underwent treatment three times a week for five weeks, which greatly diminished her symptoms and gave her relief. I also prescribed some Chinese herbs for her constipation, and treated her depression with points on the top of her head (Shi Sheng Chong), which helped lessen her depression. Treating emotional disturbances is very important as it is one of the most effective remedies for IBS. Once Lucy’s depression, anxiety, and panic attacks were brought under control, her IBS symptoms were greatly reduced.

 

Tips for Personal Use

  • Take it easy. Emotional stress is very harmful for IBS.
  • Focus on acupressure points St 36 and RN 6. Acupressure the points with your thumb or knuckle, pressing with comfortable pressure on the points; count to 20, then change to another point.
  • Get deep massages and use a heating pad.

 

 

43. Acupuncture and Insomnia

Jul 28, 2012   //   by drxuacupuncture   //   Blog, Case Discussions, Uncategorized  //  No Comments

News Letter, Vol. 4 (7), July  , 2012, © Copyright

 

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

Robert Blizzard III, DPT

www.drxuacupuncture.co

Rehabilitation Medicine and Acupuncture Center

1171 East Putnam Avenue, Building 1, 2nd Floor

Greenwich, CT 06878

Tel: (203) 637-7720

Fax: (203)637-2693

 

Insomnia

Alice E, a forty-five-year-old woman, came to me complaining of insomnia. She had the same difficulty falling asleep, especially after experiencing stress, that she’d had at college on the nights before exams. She would lie in her bed, staring at the ceiling, and not fall asleep. If she was lucky enough to doze off, she would wake up frequently, even at the slightest noise. She had experienced this problem for about ten years, but recently the problem had escalated, owing to her marital situation. Her husband, the CEO of a large company, had quit his job because he would not fly from New York to Houston each Monday, then return to New York each weekend. He had managed this schedule for two years, but it had become too burdensome to him, hence his decision to quit. Though he sent out many résumés each week, his job search had produced no results, and the family’s financial situation had become difficult over the six months her husband had been unemployed. For the last two or three months, she could only sleep an hour or two each night, owing to stress, and this caused her difficulty during the day, as she found it hard to concentrate on any issue. This sleep deprivation impaired her memory, her social interactions, and her motor coordination, which caused problems with her driving. It was at this point she consulted me.

 

Types and Causes of Insomnia

Insomnia is a symptom, not a disease. It is defined as difficulty in initiating, or maintaining, sleep—or both. It is due to an inadequate quality or quantity of sleep. Most adults have experienced insomnia or sleeplessness at one time or another in their lives.

Insomnia can be classified based on the duration of the problem:

  • Transient insomnia. These symptoms last less than one week.
  • Short-term insomnia. Symptoms last between one and three weeks.
  • Chronic insomnia. Symptoms last longer than three weeks.

Most Common Reasons for Insomnia

  • Stress. Many people experience stress from the environment, including that caused by life, work, family, and the like. This keeps them thinking about the stress and trying to deal with it, which makes falling asleep extremely difficult.
  • Anxiety. Everyday activity and anxiety, or severe anxiety disorder may keep the mind too alert to fall asleep.
  • Depression. This is a very pronounced reason to keep people alert and make sleep difficult.
  • Long-term use of sleep medication. Drugs such as Ambian or Wellbutrian cause psychological dependence on them.
  • Pain. Many conditions, including arthritis, fibromyalgia, neuropathy, trigeminal neuralgia, plus assorted injuries, will cause pain, making it hard to fall asleep and stay asleep.
  • Aging. When people age, they do not need as much sleep as they did when young. The reasons for this include changing life patterns, family changes, and other worries, all of which can cause insomnia.

 

Treatments in Western Medicine

From the perspective of Western medicine, there are two major types of treatments.

Non-Medicinal Treatments and Behavioral Therapy

  • Sleep hygiene. This is a component of behavioral therapy, with several simple steps that can be taken to improve the quality and quantity of sleep, such as timing of sleep, food intake, sleeping environment etc. Sleep hygiene combines advice about aspects of sleep control, how to avoid sleep deprivation, and how to respond to unwanted sleep interruptions if they occur.
  • Increased exercise. Exercising a minimum of 45 minutes a day, 6 days a week, will greatly improve the quality of sleep.
  • Relaxation therapy. Massage, meditation, muscle relaxation, or a hot bath or shower can assist in falling, and staying, asleep. No one should ever try to force themselves to sleep, but should retire in a relaxed mood.
  • It is best to keep a regular sleeping and waking schedule and not drink caffeine, or any beverage, before sleeping. Nor is it good to smoke. Do not go to bed hungry, and make sure the sleeping chamber is adjusted for light, temperature, and noise to make sleeping easier.
  • Stimulus control: It’s important to go to bed as soon as you feel sleepy, and not watch television, read, eat, or worry in bed. It is not advisable to take long naps during the day. (Oversleeping does not improve insomnia.)

Medication

  • Benzodiazepines. There are many different types, including temazepam, lorazepam, triazolam, and clonazepam. All of these benzodiazepines are very effective in improving the quality and quantity of sleep.
  • Nonbenzodiazepine medicine, which includes Lunesta, Sonata, and Ambien.
  • Melatonin. This is a hormone secreted by the pineal gland. It is produced during the night and helps body relaxation. (Attention needed here, however, because regular use causes the body to permanently lose its ability to produce the hormone.)
  • Rozeren. This will stimulate the melatonin receptor to improve sleep quality and quantity.
  • Some antidepressants, such as Elavil, Endep, or Desyrel, have also been used for a long time to aid in depression as well as sleep.
  • Antihistamines. Benadryl, for example, and other antihistamines can be used to induce drowsiness. The drawback to this is that, during the day, they can make it dangerous for a patient to drive or operate machinery.

 

Treatments in Traditional Chinese Medicine

Chinese medicine indicates five types of insomnia.

Excessive Fire in the Heart and Liver

The main symptom is irritability, difficulty falling asleep, sleeping intermittently, waking up easily, sometimes experiencing dizziness, dry mouth, bitter taste in the mouth, and dry tongue body, with yellowish coating on the tongue and a rapid pulse. The method of treatment is to decrease the excessive fire of the liver and heart. The acupuncture points are Xing Jian, Feng Chi, Sheng Men, and An Mian.

Table 7.1

Points Meridian Number Conditions Helped
1 Xing Jian Liver 2See Figure 7.1 Insomnia, abdominal distension, headaches, dizziness and vertigo, congestion, swelling and eye pain, deviation of the mouth, hernia, painful urination, retention of urine, irregular menstruation, epilepsy, convulsions
2 Feng Chi GB 20See Figure 7.3
3 Sheng Men Heart 7See Figure 7.4
4 An Mian Ex HN13See Figure 7.2 Insomnia, vertigo, headaches, palpitations, mental disorders

Please refer to the accompanying Figures (illustrations) for the locations

of the points. And please note that these illustrations are for information

only and may not show all the exact locations of the acupuncture points.

 

Figure 7.1

 

 

Figure 7.2

 

Fig 7.3

 

 

Fig 7.4

 

 

These points can calm the mind and improve sleep. Xing Jian belongs to the liver meridian which, when treated, can decrease the fire of the heart and liver. Feng Chi is located in the gallbladder meridian, and together with Sheng Men, a point of the heart meridian, they will decrease the fire of the liver and heart, and help to calm the brain. An Mian is also a very important point for alleviating insomnia.

Overeating

Many people experience a restless night after overeating; they feel bloated and gaseous, and have constipation or diarrhea, with white coating on the tongue. The treatment is to strengthen the spleen and stomach to calm the mind and induce sleep. The acupuncture points are Pi Shu, Zu San Li, Sheng Men, and An Mian. Pi Shu and Zu San Li are the best points for the stomach bloating, constipation, and diarrhea. Digestion will be much improved by stimulating Pi Shu and Zu San Li. As mentioned, Sheng Men and An Mian will greatly facilitate sleep.

Table 7.2

Points Meridian Number Conditions Helped
1 Pi Shu UB 20See Figure 7.8
2 Zu San Li Stomach 36
3 Sheng Men Heart 7See Figure 7.4 See Table 20.2
4 An Mian Ex HN13See Figure 7.2 Insomnia, Vertigo

Please refer to the accompanying Figures (illustrations) for the

locations of the points. And please note that these illustrations are

for information only and may not show all the exact locations of

the acupuncture points.

 

Fig 7.5

 

Depression and Sadness with Deficiency of Lung Energy

The main symptoms are depression, low energy, slowed conversation with low tone, accompanied by congested lungs, difficulty sleeping, and always waking up during the night. Sometimes there is a shortness of breath and a thin white coating on the tongue, with a deeply weak pulse. The points should be Fei Shu, Lie Que, Sheng Men, and An Mian. The acupuncture points will help the energy of spleen, stomach, and lung to improve their function.

Table 7.3

Points Meridian Number Conditions Helped
1 Fei Shu UB 13See Figure 7.7
2 Lie Que Lung 7See Figure 7.6
3 Sheng Men Heart 7Fig 7.4 See Table 20.2
4 An Mian Ex HN13See figure 7.2 Insomnia, vertigo, headaches, palpitations, mental disorders

Please refer to the accompanying Figures (illustrations) for the locations

of the points. And please note that these illustrations are for information

only and may not show all the exact locations of the acupuncture points.

 

Fig 7.6

 

 

 

Fig 7.7

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Disharmony of the Heart and Kidney

The main symptoms are anxiety, chest pain, difficulty maintaining asleep and easily waking up, heart palpitations, and stress, as well as weakness of the low back and legs, night sweats, and hot flashes, with red coating of the tongue and rapid and weak pulse. The points are Sheng Shu, Tai Xi, Sheng Men, and An Main.

Table 7.4

Points Meridian Number Conditions Helped
1 Sheng Shu UB 23

See Figure 14.1See Table 14.42Tai XiKidney 3

See Figure 16.6See Table 16.23Sheng MenHeart 7

See Figure 20.2See Table 20.24An MianEx HN13

See Figure 23.2Insomnia, vertigo, headaches, palpitations, mental disorders

Please refer to the accompanying Figures (illustrations) for the locations

of the points. And please note that these illustrations are for information

only and may not show all the exact locations of the acupuncture points.

 

Deficiency of Qi (Energy) and Blood

The main symptoms of this type of insomnia are dizziness, drowsiness, forgetfulness, poor sleep, tinnitus, and weakness, as well as cold in all the extremities, a pale face and tongue, poor digestion, and a weak pulse. The method of treatment is to calm the mind, and tonify the blood and qi, thus improving sleep. The points are Pi Shu, Sheng Shu, San Yin Jiao, Sheng Men, and An Mian.

Table 7.5

Points Meridian Number Conditions Helped
1 Pi Shu UB 20

See Figure 7.8 2Sheng ShuUB 23

See Figure 7.8 3San Yin JiaoSpleen 6

See Figure 7.9 3Sheng MenHeart 7

See Figure 20.2 4An MianEx HN13

See Figure 23.2Insomnia, vertigo, headaches, palpitations, mental disorders

Please refer to the accompanying Figures (illustrations) for the locations

of the points. And please note that these illustrations are for information

only and may not show all the exact locations of the acupuncture points.

Fig 7.8

 

 

Fig 7.9

 

 

 

 

Alice’s Treatment

Since stress caused her poor sleep, Alice belongs to type three. I selected the acupuncture points UB 13 Fei Shu, Lu 7 Lie Que, Heart 7 Sheng Men, and Ex HN13 An Mian, and she reported that, after the first treatment, she slept three to four hours. After the second week, her sleeping increased to five or six hours a night and she was starting to feel much better. After a month, her sleep pattern became normal, and she could sleep through the night. Her husband’s news that he found a job locally and would no longer have to commute to New York also alleviated her stress, which further helped her establish a normal pattern of sleep. After her course of treatment, Alice thanked me for how much I had helped her achieve relief from her insomnia.

 

Tips for Personal Use at Home

  • Take a hot shower and then press An Mian points (see Figure 23.2) for 15 minutes on each side before you go to bed. Acupressure the points with your thumb or knuckle, pressing with comfortable pressure on the points.
  • Do not force yourself go to bed if you do not have desire to sleep.
  • Do physical exercise at least 45 minutes per day, 6 days per week. The exercise will help you a lot.

 

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