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20. Acupuncture and Wrist Pain

Aug 22, 2010   //   by drxuacupuncture   //   Blog, Case Discussions, Uncategorized  //  No Comments

News Letter, Vol. 2 (8), August, 2010, © Copyright

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

www.drxuacupuncture.co

Rehabilitation Medicine and Acupuncture Center

1171 East Putnam Avenue, Building 1, 2nd Floor

Greenwich, CT 06878

Tel: (203) 637-7720

Wrist Pain




Margaret D., a 45-year old pianist and professor at a music school in New York, had been preparing for a European concert for a year and was thus practicing more than usual.  A month before she was due to depart for Europe, she began experiencing a constant and severe pain in her left wrist. The pain, which was sharp, originated near the base of her thumb and gradually spread farther back into her forearm.  When she played the piano or tried to grasp or pinch an object, she felt a sharp pain in her wrist.  She also felt some numbness at the back of her thumb and index finger, and found a fluid-filled cyst on her left wrist.  Overall, she had difficulty moving that thumb and wrist.  She was extremely nervous and upset when she consulted me, fearing she might have to cancel her European concert.

Upon examining her, I found that her left wrist was swollen and extremely tender, especially at the base of the thumb.  Margaret was unable to bend her wrist or grasp a book or a cup.  Believing that she had de Quervain tenosynovitis, I performed the ‘Finkelstein test’ to determine the source of Margaret’s pain.  I asked her to hold her thumb in the palm of her hand and bend her wrist toward the little finger.  Margaret felt immediate exacerbation of the pain, which confirmed my diagnosis of de Quervain tenosynovitis.

De Quervain tenosynovitis affects two tendons: the extensor pollicis brevis and the abductor pollicis longus, which are located on the lateral side of the wrist.  These run parallel to each other and pass through the wrist in the synovial sheath.  This sheath enables the tendons to exercise their function: i.e. flexing and extending the thumb, like when you make a fist.

Some doctors believe the cause of de Quervain tenosynovitis is unknown.  Others believe that it can be caused by repetitive exercise such as playing piano, like in Margaret’s case.  Overuse of the two tendons can cause wrist pain, swelling, numbness or a tingling sensation when the nerve is pinched.  The differential diagnosis also includes osteoarthritis of the first scarpometacarpal joint: i.e. the osteoarthritis at the base of the thumb.

There are various ways of treating this condition:

  1. Western medicine:
    1. Non-steroid anti-inflammatory drugs such as ibuprofen, naproxen, Aleve, etc.
    2. Steroid injections, which are often extremely effective, however, the side effect is that steroid might cause the tendon become fragile and easily reinjuried.
    3. Natural treatment:
      1. Immobilization of the thumb by using a spica splint, which fixes the thumb in place, promotes total rest, and avoids any thumb movements. 2. Hot/cold compresses can be effective.  First apply a heating pad to the affected area to induce blood flow to the                  affected thumb and wrist, which will flush away the inflammatory factors.  Next, apply ice packs to drive away the                  inflammatory fluids.

2.Acupuncture.  The three most important points to utilize in this treatment are

  1. Large Intestine 4 He Gu, which serves to increase the endorphin secretion in the brain. It can thus synchronize with local points to decrease the pain signals from the brain.
  2. Large Intestine 5 Yang Xi and San Jiao 4 Yang Chi.  LI 5 is the point located exactly in-between the tendons of the extensor pollicis brevis and the abductor pollicis longus of the distal insertion.  SJ 4 is adjacent to the LI 5, and will help the healing effects of LI5. Heating this area will increase the amount of blood flow and wash away the inflammation.  Electrically stimulating the two needles will continually increase the energy flow to the area to decrease the feeling of pain.
  3. Large intestine 11 Qu Chi. LI 11 is the point along the same meridian of LI5 and helps decrease the pain by activating energy from the distal meridian.
Points Meridian/No. Location Function/Indication
1 He Gu LI 4 See table 3-1/Pic 3-4 See table 3-1
2 Yang Xi LI 5 On the radial side of the wrist, when the thumb is tilted upwards, it is in the depression between the tendons of m. extensor pollicis longus and brevis Headache, redness, pain and swelling of the eye, toothache, sore throat, pain of the wrist
3 Yang Chi SJ 4 On the transverse crease of the dorsum of wrist, in the depression lateral to the tendon of m. extensor digitiorum communis. See Pic 11-1. Pain in the arm, shoulder and wrist, malaria, deafness, thirst.
4 Qu Chi LI 11 See table 4-1/Pic 4-2 See table 4-1

Pic 8-3

Margaret received acupuncture treatment three times a week for four weeks then came in twice a week for an additional six visits with the electrical stimulation and heated needle treatments.  She also wore the spica splint and used an ice massage treatment immediately after practicing piano.  Her pain decreased significantly and she went to Europe for her piano tour.  As a reward to me, she brought her CDs recorded in her Europe trip to me. She had very successful performance.

Tips for acupuncturists:

  1. In addition to the above points, you may add a few Arshi points along the insertional tendons of extensor pollicis brevis and abductor pollicis longus. Note that the distal tendons are located in the lateral wrists, and are also called the “snuff box”.
  2. Recommend that the patient wear the spica splint, which will immobilize the patient’s wrist and accelerate the healing process.

Tips for patients:

  1. The sooner treatment is commenced, the better chance you have of recovering; you should not wait to consult the doctor.
  2. Resting and immobilization are necessary.  Many physicians think the cause of this condition is idiopathic (unknown), but my observation is that mechanical repetitions of the thumb cause this condition.
  3. After acupuncture and heating and electrical stimulation, it is best to apply ice to the wrist, which in turn helps decrease the inflammation.

19. Acupuncture and Elbow Pain

Jul 25, 2010   //   by drxuacupuncture   //   Blog, Case Discussions, Uncategorized  //  No Comments

 

News Letter, Vol. 2 (7), July, 2010, © Copyright

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

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

Rehabilitation Medicine and Acupuncture Center

1171 East Putnam Avenue, Building 1, 2nd Floor

Greenwich, CT 06878

Tel: (203) 637-7720

Both Side Elbow Pain


Christina W. is a 25-year-old violinist who recently graduated from music school.  With a large tuition loan to repay, Christina teaches 30-40 students a day via group lessons.  During the few months prior to consulting with me, Christina began to feel pain in her left lateral and medial elbow.  The pain was constant, and whenever she played her violin, she experienced elbow pain, which radiated from the inside of the elbow into the forearm and wrist.  When she flexed her wrist, the pain worsened and she also experienced weakness in her forearm.  When she held an object such as a book or coffee cup, shook hands, or turned a doorknob, the pain became unbearable.  She had no numbness or tingling sensation, but was unable to play tennis or golf.  Her doctor told her to take Tylenol or Advil, but because her symptoms did not improve, she decided to consult me.

I noted that Christina experienced severe tenderness at the lateral and medial portions of her elbow.  The pain increased significantly when I asked her to flex or extend her wrist.  I concluded that Christina was suffering from both tennis elbow (lateral epicondylitis) and golf elbow (medial epicondylitis).  The causes of these conditions are as follows:

  1. Recreational sports such as tennis ground stroke, racquetball, squash and fencing, etc.
  2. Occupational tasks associated with playing musical instruments, painting, plumbing, weaving, raking and the like.

Tennis elbow and golf elbow are not always the result of playing sports, and are simply caused by repetitive wrist extension and wrist flexing which leads to inflammation of the medial and lateral epicondyles.  The diagnosis of both these conditions is routine—the doctor should take the patient’s history and perform a physical examination. X-rays are not necessary.  Occasionally, however, an MRI may be used to show the changes in the tendon at the site of the attachment to the bone.

Tennis and golf elbow can be treated non-surgically or surgically; in Christina’s case surgery was not called for, and she instead underwent these treatments:

  1. Rest, and cessation of any activity that may have caused the condition.
  2. Ice packs applied to the outside and inside parts of the elbow.
  3. Ingestion of acetaminophen or other anti-inflammatory medications for pain relief.
  4. Orthotics to diminish the symptoms. The orthotics (i.e. an elbow splint) should be tightly attached to the elbow in order to prevent the stretching of either the lateral epicondyle tendons (such as extensor carpi radialis longus, extensor carpi radialis brevis and extensor carpi ulnaris, etc.) or the medial epicondyle tendons (such as Flexor carpi radialis, flexor carpi ulnaris and flexor digitorum superificialis, etc.). See Pic 7-1 below:Acupuncture, which is very effective if started early, and at the correct acupuncture points.

To treat Christina’s lateral epicondylitis, I used the following acupuncture points: LI 10 Shou San Li, LI 11 Qu Chi, LI 12 Zhou Liao, and Arshi points.  The Arshi points should be selected in this manner:

Feel the tendons of the lateral epicondyle attached to the radial head, then insert the needles between the bone and tendon in order to separate the bone and the tendon.  Usually, two to four Arshi points are used, followed by an electrical stimulation that should be applied with as high an intensity as tolerable for 23-30 minutes. (See Pic 10-2)

The process is similar for treating medial epicondylitis.  The acupuncturist should use Heart 3 Xiao Hai and three to four Arshi points.  The Arshi points will allow the doctor to follow the tendon of the wrist to the site where the tendon is attached to the bone.  Three to four needles should be vertically inserted along this tendon attachment.  A high level of electrical stimulation should then be applied for about 25 to 30 minutes. (See Pic 7-2)

Points Meridian/No. Location Function/Indication
1 Shou San Li LI 10 On the line between LI 5 and Li 11, 2 inches below LI 11 Abdominal pain, diarrhea, toothache, swelling of the cheek, motor impairment of the upper limbs, pain in the shoulder and back
2 Qu Chi LI 11 See table 4-1/Pic 4-2 See table 4-1
3 Zhou Liao LI 12 When the elbow is flexed, the point is superior to the lateral epicondyle of the humerus, about 1 inch superlateral to LI 11, on the medial border of the huerus Pain, numbness, and contracture of the elbow and arm
4 Xiao Hai Heart 3 When the elbow is flexed into a right angle, the point is in the depression between the medial end of the transverse crease of the wrist Chest pain, spasmodic pain of the elbow and arm, sudden loss of voice

Table 7-1

 

The acupuncture-points stimulation should be followed by an acupressure massage.  This friction massage should help to loosen the attachment of the inflamed tendon to the bone, and subsequently decrease the symptoms associated with tennis and golf elbow.

Other options for tennis and golf elbows are steroid injections and surgery, but neither was necessary in Christina’s case.  After three weeks of a combination of acupuncture, acupressure, and massage treatments, during which she was advised not to play her violin, her pain had decreased significantly.

Tips for acupuncturists:

  1. Correct direction of the needle insertion: the needles should be inserted between the bone and the tendons for the purpose of trying to separate the adhesion of the inflamed tendon and bone.
  2. Use friction massage: by moving your fingertips over the tendon head, you may detach the adhesion between the inflamed tendon and bone.

Tips for patients:

  1. You should put ice on the tender points and then perform the friction massage 15 minutes, two times a day.
  2. Stop playing sports, such as tennis, golf and other upper-extremity activities for at least one month or more, depending on the severity of the condition.

18. Acupuncture and Rotator Cuff Tear-Shoulder Pain 2

Jun 27, 2010   //   by drxuacupuncture   //   Blog, Case Discussions, Uncategorized  //  1 Comment

 

News Letter, Vol. 2 (6), June, 2010, © Copyright

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

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

Rehabilitation Medicine and Acupuncture Center

1171 East Putnam Avenue, Building 1, 2nd Floor

Greenwich, CT 06878

Tel: (203) 637-7720

ROTATOR CUFF TEAR

Matthew P., a 45-year-old man, injured himself after pitching a few baseballs to his son.   He felt a sudden onset of right shoulder pain, which was so severe that he could not raise his arm, and this considerably interfered with his daily activities.

When I questioned him, Matthew told me he had experienced this pain on and off for more than six months, but it was mild enough that he did not feel it was necessary to see a doctor.  This pain was present both during daily activities and at night, radiating from the front of the shoulder to the side of the arm.  It had been steadily worsening, and the injury was exacerbated by the fact that his son had just returned from boarding school two weeks before and they began playing baseball together again.  Within those couple of weeks, Matthew’s condition had worsened and he was no longer able to raise his arm to a 90-degree angle.

When I performed the physical examination, I found that his right shoulder was moderately swollen and very tender to the touch at the front and back of the deltoid area.  He also had a painful arc of movement between 60 and 120 degrees.  I had to help him raise his arm from 60 to 90 degrees, which caused him pain, but once he got it past the 120 degree mark he could do it himself and the pain subsided.  I also tried a drop arm test—I lifted his right arm passively up to 90 degrees, then let go—and he had difficulty maintaining the arm at this position on his own.

Based on the above observations, I concluded that Matthew had most likely torn his rotator cuff.  This condition has different names: rotator cuff tendonitis, rotator cuff inflammation, shoulder impingement syndrome, rotator cuff bursitis, etc.  The most common symptom is that patients experience gradual onset of shoulder pain with difficulty in raising the arms up to 120 degrees.  The impingement of the rotator cuff tendons is the most common cause of shoulder pain.

The rotator cuff is a group of tendons composed of four muscles: the supraspinatus, infrapinatus, subscapularis and teres minor.  These muscles cover the head of the humerus, and combined with the deltoid muscle, they form the bow of the shoulder.   The muscles’ function is to rotate and lift the shoulder.

http://www.achesandjoints.com/images/anj4/RotatorCuff-s.jpg

The acromion is the front edge of the shoulder.  It normally sits over and in front of the humeral head when the arm is lifted and in most cases will not rub the tendons of the rotator cuff.  However, in some cases, the acromion might wrap or impinge on the surface of the rotator cuff, which causes pain and limits the shoulder movement; this is called impingement syndrome.  There are three stages of rotator cuff impingement syndrome:

  1. Stage one: edema or hemorrhage stage. This usually occurs when a patient is under 25 years old. The shoulder shows acute pain, edema or hemorrhage with signs of inflammation. This stage is reversible and surgery is rarely used to treat the condition.
  2. Stage two: fibrosis and tendonitis stage.  The inflamed rotator cuff tendons continue to get worse, and develop to fibrosis and tendonitis.  This most often occurs between age 25 and 40. Conservative treatment and surgery should both be considered, depending on the severity of the patient’s condition.
  3. Stage three: arcomioclavicular spur and rotator cuff tear.  This stage occurs because of continuous mechanical disruption of the rotator cuff tendon between the arcomioclavicular and humoral head. Surgical anterior acromioplasty and rotator cuff repair is usually required.

Matthew appeared to have stage two (rotator cuff tear). In order to make a clear diagnosis of the disease, I ordered X-rays.  They showed a  anterior spur, which caused the impingement of the rotator cuff and the pain.

When Matthew played ball with his son, he had traumatized his shoulder, causing the rotator cuff to partially tear.

Treatment:

Western medicine is usually administered in four stages:

  1. Nonsurgical treatment: the patient takes a course of oral prednosone or some form of non-steroid, anti-inflammatory medication.
  2. The patient avoids strenuous activity and puts an ice pack on the injured shoulder.
  3. Injection of a local steroid into the affected area.
  4. Physical therapy: this can take from several weeks to a number of months.  Many patients experience gradual improvement and a return to normal function.

Surgical treatment is usually indicated for full thickness or partial tears that failed to improve with conservative treatment.  There are two kinds of surgical techniques.

  1. Arthrosopic technique: two or three small puncture wounds are made and a small instrument is inserted to remove the surface of the arcomion and clean out the injured tissue of the rotator cuff.
  2. Open technique: open surgery that cuts into the shoulder and allows direct visualization into the acromion and rotator cuff.

Matthew was offered all these options, but because of his work, he could not afford to take off time, and thus opted for a conservative treatment.

I first combined physical therapy with acupuncture, and advised him to put an ice pack on his shoulder immediately, and rest his arm as much as possible, strictly avoiding any activities that might aggravate the symptoms.

I then introduced acupuncture to decrease the pain.  I used  “the three famous shoulder needles” technique: Jian Qian, Jian Yu, and Jian Zhen.  All of these must be inserted 2-3 inches deep into the respective anatomic points: the rotator cuff including bicepital, supraspinator tendons, and acromial bursa etc.  Then, a strong electrical stimulation should be used to bring a large amount of blood flow to the shoulder and wash away the inflammation to gradually diminish the sensation of pain and improve the range of shoulder motion.

The ancillary points include LI 14 Bi Nao, SJ 5 Wai Guan, LI 4 He Gu and LI 11 Qu Chi.  The patient was treated for about three months and, after passing through the acute stage, I gradually strengthened his rotator cuff muscle and after six months his shoulder had returned to normal.  His range of motion also returned to normal, and there was no need for surgery.

Table 8-1

Points Meridian/No. Location Function/Indication
1 Jian Qian Extra 23 Midway between the end of the anterior axillary fold and LI 15, Jian Yu Pain in the shoulder and arm, paralysis of the upper extremities
2 Jian Yu LI 15 Antero-inferior to the acromion, on the upper portion of m. deltoideus. When the arm is in full abduction, the point is in the depression appearing at the anterior border of the acromioclavicular joint Pain in the shoulder and arm, motor impairment of the upper extremities, rubella, scrofula
3 Jian Zhen SI 9 Posterior and inferior to the shoulder joint. When the arm is adducted, the point is 1 inch above the posterior end of the axillary fold Pain in the scapular region, motor impairment of the hand and arm
4 Bi Nao LI 14 On the line joining Qu Chi (LI 11) and Jian Yu (LI 15), 7 inches above Qu Chi (LI 11), on the radial side of the humerus, superior to the lower end of the m. deltoideus Pain in the shoulder and arm, rigidity of the neck, scrofula.
5 Wai Guan SJ 5 See table 5-1/Pic 5-3 See table 5-1
6 He Gu LI 4 See table 3-1/Pic 3-4 See table 3-1
7 Qu Chi LI11 See table 4-1/Pic 4-2 See table 4-1

Pic 8-1

Tips for both acupuncturists and patients:

1.   If the patient has rotator cuff tendonitis or impingement, and is less than 25 years old and in the acute stage, an ice pack on the shoulder to decrease both the edema and inflammation, followed by acupuncture, is usually a sufficient cure.

2.   If the patient has stage two fibrosis and tendonitis, and is between the ages of 25 and 40, acupuncture should start as soon as possible, as described above.  This is usually sufficient treatment at this stage.

3.   If the patient has stage three acromioclavicular spur and rotator cuff tear, and is over the age of 40, doctors should cautiously examine treatment options.  The patient should have an X-ray and MRI without contrast to discover if the patient has a partial or complete tear, and he should consult an orthopedic surgeon to see if surgery is necessary.  If the patient is young and the injury is related to sports, the torn rotator cuff should be sutured as soon as possible in order to accelerate a complete recovery.

17. Acupuncture and Frozen Shoulder-Shoulder Pain 1

May 26, 2010   //   by drxuacupuncture   //   Blog, Case Discussions, Uncategorized  //  No Comments

News Letter, Vol. 2 (5), May, 2010, © Copyright

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

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

Rehabilitation Medicine and Acupuncture Center

1171 East Putnam Avenue, Building 1, 2nd Floor

Greenwich, CT 06878

Tel: (203) 637-7720

Frozen Shoulder-Shoulder Pain 1



 

The above photo is coming from: www.1thing.info/50kata/gojukata1.gif

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

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

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

Frozen shoulder is usually exhibited in three stages:

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

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

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

Western medicine treatments:

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

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

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

Traditional Chinese Medicine Treatment:

 

The following points were selected:

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

Table 7-1

Points Meridian/No. Location Function/Indication
1 Jian Qian Extrapoints 23

Midway between the end of the anterior axillary fold and LI 15, Jian Yu

Pain in the shoulder and arm, paralysis of the upper extremities
2 Jian Yu LI 15 See table 5-1/Pic 5-1 See table 5-1
3 Jian Zhen SI 9 Posterior and inferior to the shoulder joint. When the arm is adducted, the point is 1 inch above the posterior end of the axillary fold Pain in the scapular region, motor impairment of the hand and arm
4 Jian Liao SJ 14 Posterior and inferior to the acromion, in the depression about 1 inch posterior to LI 15 Jian Yu, when the arm is abducted. Pain and motor impairment of the shoulder and upper arm
5 Nao Shu SI 10 When the arm is adducted, the point is directly above SI 9 Jian Zhen, in the depression inferior to the scapular spine Swelling of the shoulder, aching and weakness of the shoulder and arm
6 Tian Zhong SI 11 See table 5-1/Pic 5-2 See table 5-1
7 Ju Gu LI 16 In the upper aspect of the shoulder, in the depression between the acromial extremity of the clavicle and the scapular spine Pain and motor impairment of the upper extremities, pain in the shoulder and back
8 Tiao Kou St 38 2 inches below St 37 Shang Ju Xu, midway between St 35 Du Bi and St 41 Jie Xi. Numbness, soreness and pain of the knee and leg, weakness and motor impairment of the foot, pain and motor impairment of the shoulder, abdominal pain
9 Cheng Shan UB 57 Directly below the belly of m. gastrocnemius, on the line joining UB 40 Wei Zhong and tendo calcaneus. About 8 inches below UB 40. Low back pain, spasm of the gastrocnemius, hemorrhoids, constipation, beriberi
10 Wai Guan SJ 5 See table 5-1/Pic 5-3 See table 5-1
11 He Gu LI 4 See table 3-1/Pic 3-4 See table 3-1
12 Qu Chi LI 11 See table 4-1/Pic 4-2 See table 4-1

Pic 7-1

Pic 7-2

Pic 7-3

Pic 7-4

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

Tips for acupuncturists:

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

Tips for patients:

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

16. Acupuncture and Cervical Spondylosis-Neck Pain

Apr 28, 2010   //   by drxuacupuncture   //   Blog, Case Discussions, Uncategorized  //  4 Comments

News Letter, Vol. 2 (4), April, 2010, © Copyright

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

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

Rehabilitation Medicine and Acupuncture Center

1171 East Putnam Avenue, Building 1, 2nd Floor

Greenwich, CT 06878

Tel: (203) 637-7720

 

Cervical Spondylosis (neck pain)

Thomas W. is a 65-year-old man who woke up one morning with neck pain that appeared seemingly out of nowhere.  He told his doctor the pain was extremely severe: a shooting pain that traveled downwards from his stiff neck to his shoulder blade.  He was unable to move his neck forward or backward, and had trouble turning it from side to side.  His condition made it dangerous for him to drive as he could not check for cars coming up beside him, and could not change lanes.  The pain was constant, sometimes dull, sometimes sharp, but with no associated burning sensation, numbness or tingling in his arms.  Occasionally, the pain radiated up to his scalp.

His primary care physician referred him to an orthopedic doctor.  This doctor ordered an X-ray, which showed that Thomas had cervical spondylosis.

He was prescribed physical therapy as his sole treatment.  He underwent physical therapy three times a week for five weeks, which alleviated the stiffness to some degree, but did nothing for the pain.

Thomas then came to me for evaluation and treatment.

Cervical spondylosis is a degenerative change that affects the spinal process, causing degeneration in the discs and joints between the vertebrae, i.e. arthritis in the neck.  It usually affects people over the age of 40; men are more prone to cervical spondylosis than women.  When the vertebral body and disc, as well as the different ligaments along the cervical spine, go through degenerative change, the patient gradually begins to experience neck stiffness.  Those affected usually try to adjust their own neck functions and flexibility to the stiffness; however, at some point they will feel severe pain because their bodies can no longer accommodate the changes.

The severity of symptoms depends on the location of the degeneration. If the compression affects the discs and ligaments, the patient will feel stiffness and have a limited range of motion, with difficulty turning the head backward and forward, and difficulty looking over his/her shoulder.  If the cervical nerve roots are compressed, inflammation and impingement of the nerve roots may result.  The patient may feel neck pain radiating to the shoulder, arm and hands, associated with numbness, weakness, headaches, and urinary and bowel incontinency.

Western medicine treatments for Cervical Spondylosis:

  1. Cervical collars: to stabilize the neck, and prevent additional neck instability, which might lead to paralysis of the legs and/or arms, a doctor will usually prescribe a soft cervical collar.  If a soft collar is not sufficient, the doctor may try a more rigid brace for the neck; however, these collars will restrict the patient’s range of movement of the neck and may, in the long run, exasperate the patient’s stiffness and pain further.  Thus, this method is not very effective.
  2. Physical therapy: involves the use of a heating pad, electrical stimulation, ultrasound technology, massages, and cervical stretches.  These treatments can often be very helpful to the patient.
  3. Surgery: if the above treatments do not work, surgery may be for the next best option. Surgery is based on the following criteria:
    1. The conservative measure of a cervical collar does not work.
    2. There is severe pain.
    3. There is significant neurological damage, such as difficulty in raising the arm, weakness, or bladder problems.
    4. There is a compression of the spinal cord.

There are two main types of surgery used to treat cervical spondylosis:

  1. Laminectomy: a spine operation to remove the portion of the vertebral bone called the lamina, which will release the pressure to the pinched nerves.
  2. Discectomy: a surgical removal of the central portion of an intervertebral disc, the nucleus pulposus, which causes the pain by stressing the spinal cord or radiating nerves.

Thomas underwent physical therapy and used a cervical collar.  Though he felt some improvement, he was not cured.  At this point, he consulted me for further treatment.  I treated Thomas with the following traditional Chinese medicine method.

First, I applied a heating pad to the patient’s neck for 15 minutes. Then, I inserted the acupuncture needles at the: Hua Tuo Jia Ji points at the C4, C5, C6, and C7; Arshi points; Du 14 Da Zhui; LI 15 Jian Yu, LI 11 Qu Chi, SJ 5 Wai Guang, and LI 4 He Gu.  I also used the small intestine meridian points, such as SI 3 Hou Xi, SI 5 Yang Gu, SI 8 Xiao Hai, SI 12 Bing Feng, and SI 11 Tian Zong to balance the energy of the entire upper extremity region.

Table 5-1

Points Meridian/No. Location Function/Indication
1 Hua Tuo Jia Ji ExperiencePoints Cervical, thoracic and Lumbar sacral spine. See Pic 4-1 Local neck, thoracic and low back pain
2 Arshi ExperiencePoints Any tender points in the body Decrease the pain in any tender points of the body
3 Da Zhui Du 14 Below the spinous process of the 7th cervical vertebra, approximately at the level of the shoulders Neck pain and rigidity, malaria, febrile diseases, epilepsy, afternoon fever, cough, asthma, common cold, back stiffness
4 Jian Yu LI 15 Antero-inferior to the acromion, on the upper portion of m. deltoideus. When the arm is in full abduction, the point is in the depression appearing at the anterior border of the acromioclavicular joint Pain in the shoulder and arm, motor impairment of the upper extremities, rubella, scrofula
5 Qu Chi LI 11 See table 4-1/Pic 4-2 See table 4-1
6 Wai Guang SJ 5 2 inches above Yangchi between the radius and ulna Febrile diseases, headache, pain in the cheek, neck sprain, deafness, tinnitus, pain in the hypochondriac region, motor impairment of the elbow and arm, pain of the fingers, hand tremor
7 He Gu LI 4 See table 3-1/Pic 3-4 See table 3-1
8 Hou Xi SI 3 When a loose fist is made, the point is on the ulnar side, proximal to the 5th metacarjpophalangeal joint, at the end of the transverse crease and the junction of the red and white skin Pain and rigidity of the neck, tinnitus, deafness, sore throat, mania, malaria, acute lumbar sprain, night sweating, febrile diseases, contracture and numbness of the fingers, pain in the shoulder and elbow.
9 Yang Gu SI 5 At the ulnar end of the transverse crease on the dorsal aspect of the wrist, in the depression between the styloid process of the ulna and triquetral bone Swelling of the neck and submandibular region, pain of the hand and wrist, febrile diseases
10 Xiao Hai SI 8 When the elbow is flexed, the point is located in the depression between the olecranon of the ulna and the medial epicondyle of the humerus Headache, swelling of the cheek, pain in the neck, shoulder, arm and elbow, epilepsy
11 Bing Feng SI 12 In the center of the suprascapular fossa, directly above Tian Zong. When the arm is lifted, the point is at the site of the depression Pain in the scapular region, numbness and aching of the upper extremities, motor impairment of the shoulder and arm
12 Tian Zong SI 11 In the infrascapular fossa, at the junction of the upper and middle 3rd of the distance between the lower border of the scapular spine and the inferior angle of the scapula Pain in the scapular region, and in the lateroposterior aspect of the elbow and arm, asthma

Pic 5-1

Pic 5-2

Pic 5-3

Pic 5-4

The acupuncture was coupled with strong electrical stimulation, after which the patient was treated with ultrasound and massage.  After six weeks of treatment, his neck function had improved greatly and he was able to turn his head while driving without difficulty.  He therefore avoided surgery, and, while he still experienced minimal pain, the acupuncture alleviated his condition and strengthened the main function of his cervical spine.

Acupuncture alone cannot cure cervical spondylosis because degenerative changes of the cervical spine severely affect both ligaments and joints.  For people over the age of 40, it is common for calcium to be released from the bones and begin circulating in the blood.  This circulated calcium begins to affect the body’s joints, and if it reaches the cervical spine, it will cause cervical spondylosis and degeneration in the surrounding ligaments, discs and joints.  After a while, the condition will restrict the neck’s range of motion.  Acupuncture may help relieve some of the symptoms, mainly pain, but the physical degeneration cannot be reversed through this method.

Since this condition is ongoing, and can lead to difficulty in walking, numbness and tingling sensations in the arms and hands, weakness of the arms, and urinary tract incontinence, the earlier it is treated, the better.  These symptoms can quickly worsen, causing permanent loss of nerve function; in this case, surgery will be absolutely necessary.

Tips for acupuncturists:

  1. Always apply a heating pad to the patient’s neck for about 15 minutes before inserting the acupuncture needles. The heating pad will improve the energy circulation.
  2. Hua Tuo Jia Ji is a group of excellent acupuncture points; you should always use it when treating patients with neck pain.

Tips for patients:

  1. You may use a heating pad at home to help with the healing.
  2. You may adjunct the acupuncture treatment with massages and range of motion exercises for your neck.

15. Acupuncture and Severe Neck Pain and Hernic Disc

Mar 25, 2010   //   by drxuacupuncture   //   Blog, Case Discussions, Uncategorized  //  3 Comments

News Letter, Vol. 2 (3), March, 2010, © Copyright

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

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

Rehabilitation Medicine and Acupuncture Center

1171 East Putnam Avenue, Building 1, 2nd Floor

Greenwich, CT 06878

Tel: (203) 637-7720

Neck Pain and Herniated Disc

Jeffrey S. is a 35-yearold man who was involved in a motor vehicle accident from which he sustained a neck injury. He was stopped at a red light when another car rear-ended him.  He did not lose consciousness, and though he was aware that his neck had shifted backward, he felt the injury was only minor at the time. When the police officers at the scene of the accident suggested that he go to the hospital for evaluation, he did not feel sufficient pain to warrant this; plus, he had a meeting scheduled.

About two weeks later, the initial neck pain had radiated down to his right shoulder, elbow and hand, and he also felt numbness and tingling. The pain occurred on and off, especially during the night.  In the mornings when he woke up, his neck felt very stiff; the pain was severe and he could not lift heavy objects.  At this point, he visited his primary care physician, who ordered an MRI and X-ray.  These tests showed a herniated disc at C5 and C6 but no fracture.  The patient was referred for physical therapy and to a neurosurgeon.  The neurosurgeon prescribed two months of physical therapy, then a follow-up visit.

The patient attended physical therapy three times a week, but after a few weeks, the pain worsened, not only radiating down his right arm, but also between his shoulder blades.  In addition, he felt stiff and had difficulty moving his head forward and backward. His neurosurgeon gave Jeffrey a neck collar, which also did not help.  The doctor suggested that, since physical therapy had not worked, the patient should consider surgery.  Jeffrey did not want surgery.  He was a self-employed car dealer and could not afford to take the month off required for surgery and the recovery period.

He was subsequently referred to a pain-management physician who gave him epidural injections at C5-C6.  These greatly alleviated Jeffrey’s neck pain; however, a month later the pain returned and was much more severe and Jeffrey did not know what to do next.  He was referred to me for help and I was able to offer him an alternative treatment.

Common neck injuries:

Since the neck is very flexible and supports the head, it is extremely vulnerable to accidents and associated injuries.  Car accidents, sports-related accidents, contact sports and force can result in different degrees of cervical (i.e. neck) injuries.  The most common neck injuries after a car accident are:

  1. Soft tissue injury: involves the muscles and ligaments.  Usually there is no pain radiating down to the shoulder and arm, and no numbness or tingling sensation; however, the patient feels neck pain localized on the cervical spine and posterior shoulder and experiences pain and neck weakness when he/she wakes up each morning.
  2. Herniated disc injury/cervical radiculopathy: caused by moderate to severe neck injury. The most common is C5-C6 herniated discs, which impinge the cervical nerves causing the pain to radiate down to the shoulder, arm and sometimes, wrist, making the injured sides feel heavy and weak.  Very often, the patient feels pins, needles and burning sensations (cervical radiculopathy).
  3. Neck fractures or dislocations: severe neck injury will cause fractures or dislocations of the neck, which will in turn damage the spinal cord with more severe symptoms similar to the above.  Often may cause paralysis.

Jeffrey’s injury falls into the second category: cervical radiculopathy with herniated disc.

 

Western medicine: diagnosis and treatment

If a patient experiences severe neck pain after a car accident, the doctor usually orders the following tests:

  1. X-ray: most common test.  Checks for bone fractures. If the pain is not severe this test usually suffices.
  2. MRI: studies the spinal cord and nerve roots.
  3. CT scan: allows careful evaluation of the bony structure of the cervical spine.
  4. Myelography: dyed liquid is injected into the spinal cord to evaluate it and the nerve roots.
  5. EMG (electromyography): evaluates nerve and muscle function.

Jeffrey underwent the majority of these western medicine treatments, except surgery, including:

  1. Anti-inflammatory medication: Naproxen, Tylenol, Advil, etc. are administered to decrease neck inflammation. However, these medications usually just mask the pain, and incur many other side effects, such as stomach upset, peptic ulcer, and increased chance of blood clots. They cannot be expected to specifically treat the cause of the cervical herniated disc.
  2. Immobilization: most patients only need a soft collar, which gives psychological support to immobilize the neck.   In other words, if the patient feels he/she can depend on the collar for some support, the perception of pain is usually decreased to a certain degree.  In some cases, a solid cervical orthotic device might be used for unstable fractures of the cervical spine.
  3. Physical therapy: heating pads, ultrasound technology, stretching and strengthening exercises coupled with massages and range of motion exercises of the cervical spine.  This helps if the patient has soft tissue injury without a severe herniated disc.
  4. Epidural injection: the patient is put under a specific, C-arm X-ray machine. Then, a trained physician injects the steroid into the herniated area and nerve root, which decreases the inflammation and pain.  This treatment relies on the experience of the physician and the severity of the herniated disc and pinched nerve.  If the injury is too severe, epidural injection might not help, especially if the physician cannot inject the steroid into the specific point.
  5. Surgery: there are two possible surgeries for this condition:
    1. Discectomy.  The neurosurgeon might cut out only the injured portion of the disc, which will remove the pressure of the herniated disc from the nerve root.  This may cause the symptoms to decrease or disappear.  Sometimes, the entire herniated disc will disappear because of the degenerative changes in the disc tissue.
    2. Laminoctomy.  Sometimes the disc degenerates or the nerve root impingement is very severe.  In these cases, removing a part of the herniated disc through discectomy is not sufficient to relieve the pain. Thus, the surgeon may cut off a piece of the bone to open the nerve root outlet.
  6. Traction: recommended by doctors when the patient wants to avoid surgery.  This treatment pulls and slightly separates the vertebrae of the neck so that the herniated disc might return to its original place, thus relieving the pain. The neck position is extremely important in this course of treatment, The neck should not be hyperextended and pressure must be tested before flexing the neck as this could cause further damage to the cervical vertebrae.

Traditional Chinese Medicine: diagnosis and treatment

Jeffrey underwent most of the treatments listed above, without experiencing significant improvements.  Before undergoing surgery, he decided to consult me.  After a thorough physical examination, I concluded that the patient had the symptoms of right C5 and C6 nerve distribution and the herniated disc was impinged at C5-C6 nerve roots. The following table is a description for the pathophysiology of the cervical radiculopathy, i.e. the neck nerve root impingement at different root levels.

Nerve Root Disc Lesion Muscle involved Reduced Reflex Weakness Numbness
C3/C4 C2/C3 Posterior and lateral scalp, temporal muscles None None None
C5 C4 Rhomboids, Deltoid,Biceps brachii,

Supraspinatus,

Infrasponatus, Brachilis, etc.

Biceps brachii Elbow flexion Lateral arm
C6 C5 Deltoid,Biceps brachii, Brachioradialis

Supraspinatus,

Infraspinatus,

Supinator,

Pronator teres

FCR

EDC

Paraspinals

Brachioradialis Wrist extension Lateral forearm
C7 C6 Pronator teresFCR

EDC

Triceps brachii

Paraspinals

Triceps brachii Elbow extension Middle finger
C8/T1 C7 TricepsBrachii

FCU

FDP

ADM

PQ

APB

Paraspinals

None Finger flexion Middle finger

Abbreviations:

FCR: Flexor Carpi Radialis

EDC: Extersor digitorum communis

FCU: Flexor Carpi Ulnaris

FDP: Flexor Digitorum Profundus

ADM: Abductor digiti minimi

PQ: Pronator quadratus

APB: Abductor pollicis brevis

An MRI of the cervical spine without contrast (i.e. there is no contrast material injected into the blood circulation; this type of MRI decreases the amount of toxic substances injected into the body and the subsequent side effects) was ordered for Jeffrey, and is pictured below:

From the above films, it is evident that there was a herniated disc at C4, which impinged the C5 nerve root and caused the symptoms Jeffrey complained of.

I employed acupuncture to treat the injury, following the cervical spine from C5-C6 up into the lateral portions of the shoulder, upper arm and forearm.  Hua Tuo Jia Ji points are a set of specially designed points used to treat disc diseases. By palpation, you should feel the herniated disc spinal process, then insert the needles (about 0.5 inches deep) into the herniated disc, and the discs one level above and one level below the level of the herniated disc.  Then, insert needles 0.5 inches from the lateral sides of each of the three initial needles.  Thus, a total of 9 needles are inserted into the herniated disc and adjacent area.

For this particular case, I also extended this Hua Tuo Jia Ji to C4 and C7 levels. For the other parts of the body, I selected LI 15 Jian Yu, LI 11 Qu Chi, SJ 5 Wai Guan, and LI 4 He Gu.  The C5-C6 nerves connect to the lateral shoulder and the lateral upper arm; all the above acupuncture points follow these nerve roots locally.  The local acupuncture points will increase blood flow in the area, wash away inflammatory factors, and decrease the muscle spasms and inflammation. Distal acupuncture points such as the bilateral Tai Chong and He Gu should also be selected.  These largely increase the amounts of endorphins secreted in the brain, which help to decrease pain.

Pic 4-1 Hua Tuo Jia Ji Points


Table 4-1

Points Meridian/No. Location Function/Indication
1 Hua Tuo Jia Ji ExperiencedPoints Along the spine, use the most painful vertebral spinal as the midpoint, then locate the upper and lower spinal process and points located 0.5 inches on either side. You may choose two spinal processes as the starting points. See Pic 4-1 Specifically treat for local neck and low back pain, and pain along the spine.
2 Tai Chong Liv 3 See table 1-1/Pic 1-3 See table 1-1
3 He Gu LI 4 See table 3-1/Pic 4-2 See table 3-1
4 Qu Chi LI 11 Flex the elbow. The point is in the depression of the lateral end of the transverse cubital crease. Sore throat, toothache, redness and pain of the eye, scrofula, urticaria, motor impairment of the upperextremities, abdominal pain, vomiting, diarrhea, febrile disease.
5 San Yin Jiao Sp 6 3 inches directly above the tip of the medial malleolus, on the posterior border of the medial aspect of the tibia. Abdominal pain and distention, borborygmus, diarrhea, dysmonorrhea, uterine bleeding, morbid leucorrhea, prolapse of the uterus, delayed laboour, nocturnal emission, impotence, enuresis, dysuria, edema, hernia, pain in the external genitalia, muscular atrophy, motor impairment, paralysis and pain of the lower extremities, headache, dizziness and vertigo, insomnia.
6 Jian Yu LI 15 Anterior-inferior to the acromion, on the upper portion of m. deltoideus. When the arm is in full abduction, the point is in the depression appearing at the anterior border of the acromioclavicular jointSee Pic 4-2 Shoulder and arm pain, motor impairment of the upper extremities, rubella, scrofula
7 Wai Guan SJ 5 2 inches above outer wrist transverse crease; midpoint between the radius and ulnaSee Pic 4-2 Febrile diseases, headache, pain in the cheek, strained neck, deafness, tinnitus, pain in the hypochondriac region, motor impairment of the elbow and arm, pain of the fingers, hand tremor

Pic 4-2

Pic 4-3 The patient underwent my treatment for a total of 20 visits (twice a week for ten weeks).  Gradually, his pain decreased, the neck spasms and right-side arm weakness decreased, and the patient felt a large overall improvement.

Tips for both patients and acupuncturists:

I have found that the most efficacious treatment involves a combination of acupuncture, heating pads, massage and physical therapy.  I do not recommend that a patient undergo surgery immediately.  Studies have shown that surgery for this condition may show a marked improvement for about six months; however, after this period, the pain usually returns.  After two years, the patients with or without surgery may have the same level of pain (patients who did not undergo surgery were instead treated with acupuncture, physical therapy, massage and chiropractic therapy). Therefore, I recommend that patients explore other options before jumping into surgery.

A clear diagnosis is the most important factor in these cases.  For any acupuncturist to treat neck pain, he/she must first understand the mechanism of the pain.  If the pain is moderate, acupuncture treatment alone may help.  If it is more severe, it is important to refer the patient to a western doctor for evaluation.  If there is a fracture, the patient could become paralyzed and it is therefore absolutely necessary to first employ MRIs, X-rays, and CT scans to rule out skeletal instabilities.

14: Acupuncture and Trigeminal Neuralgia

Feb 25, 2010   //   by drxuacupuncture   //   Blog, Case Discussions, Uncategorized  //  2 Comments

Dear Patients and Friends:

February 14 was the first day of the Chinese New Year. This year is the year of the tiger. In Chinese tradition, the year of the tiger will usually make you look forward to the bright future and bring you an exciting fortune. Therefore, we wish you a Happy Chinese New Year of Tiger!

This month’s case discussion is about Trigeminal Neuralgia, which is common to middle and elderly aged people. We hope you may learn something from this case discussion.

Happy Chinese New Year!!!

Jun Xu, M.D. and Hong Su, C.M.D.


News Letter, Vol. 2 (2), February, 2010, © Copyright

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

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

Rehabilitation Medicine and Acupuncture Center

1171 East Putnam Avenue, Building 1, 2nd Floor

Greenwich, CT 06878

Tel: (203) 637-7720

TRIGEMINAL NEURALGIA

Sharon, a 65-year-old woman who suffered from a toothache on the right side of her mouth for a month, finally consulted her dentist who found two loose teeth in the back, right side of the mouth.  The patient loves sweets, which may have caused the problem, but the pain was so severe that she was unable to sleep.  The pain occurred proximally and started when Sharon tried to brush his teeth; the pain was so severe that she could not bear to touch the teeth or the right side of her face and jaw.  Even air currents could trigger the pain.  She had difficulty eating, talking, and brushing her teeth.  The shooting pain felt like electrical shocks and burning, and, at times, was unbearable.   It attacked the right side of the jaw and face and lasted for hours.  The patient intentionally tried not to use the right side of  teeth in order to avoid triggering an episode of pain.   Finally, the dentist decided to pull out the two lower teeth.  At this point, the patient felt immediate swelling on the right side of her face and, after a week, the pain became worse.  The doctor also prescribed narcotics to ease the pain. There was no improvement after the tooth extraction and the patient still could not touch the right side of his face.

Upon examining him, I discovered that although the pain did not extend to the right side of her eye, the right cheek and jaw were tender and the pain was described as intolerable by the patient.  She felt it was incapacitating her to the extent that she was losing normal function and had dropped ten pounds.  She also experienced fatigue and was unable to sleep.

Sharon is suffering from trigeminal neuralgia.  The trigeminal nerve carries sensation from the face to the brain.  Many studies indicate that when the superior cerebellar artery compresses this nerve, the nerves protecting the myelin sheath are injured, causing erratic and hyperactive function of the nerve.  This can lead to pain at the slightest stimulation of any area served by the nerve, as well hindering of the nerve’s ability to shut down pain signals when the stimulation ends.  The trigeminal nerve is the fifth cranial nerve, which registers sensory data such as pressure and temperature and measures pain originating from the face above the jaw line.  The trigeminal nerve has three branches, one going to the eye, the second to the mouth, and the third to the jaw.  In Sharon’s case, two of these three trigeminal branches (mouth and jaw) were affected. This condition is usually found in males and females at the ratio of 2:3, and most trigeminal neuralgia cases are idiopathic and typically occur in the sixth decade of life, although they may occur at any age.  The symptomatic or secondary trigeminal neuralgia may occur in younger patients.

The patient’s history is the most important factor in the diagnosis of trigeminal nerve neuralgia.   The nature of the pain may be brief and proximal, but it may also occur in multiple attacks and may be stabbing or shock-like or extremely severe.  It is usually distributed in one or more branches of the trigeminal nerve and is usually maxillary or mandibular and unilateral.  This pain typically lasts from a few seconds to one to two minutes and will typically occur for a few months each year.

Treatment with Western Medicine:

  1. Medications. The most typical medications prescribed by doctors and dentists are anticonvulsants such as carbamazepine, oxcababazepine, phyntoin or gabapentin.  Generally, these are the most effective for pain relief, and can be adjuncted with muscle relaxants such as baclofen.  Some opiates can also be effective such as OxyContin or Duragesic in patch form, for decreasing pain in the jaw and face, as well as low doses of antidepressants such as amitriptyline.
  2. Surgery. Surgery may relieve pressure on the nerve or selectively truncate the nerve by disrupting the pain signals from getting through to the brain. It is usually 90% successful if done by an experienced surgeon.  The most specific kind of surgery is microvascular decompression.
  3. Stereotactic radiation therapy. A surgeon uses a gamma knife or linear accelerator (a form of radiation therapy) such as the Novalis Cyberknife.  The therapy penetrates the skin and targets the selective nerve root and disrupts the pain signal transmissions.

Treatment with Traditional Chinese Medicine:

According to Traditional Chinese Medicine, the stomach meridian is distributed around the eye, the jaw, and the teeth.  Therefore, if the stomach meridian is blocked, the external wind and heat will be mutually mixed, and the wind flame will invade the stomach meridian and cause severe pain along the meridian (i.e. along the face, teeth, and eye).

The main treatment for trigeminal neuralgia is to soothe the stomach meridian by redistributing the wind, dissipating the heat and improving the energy flow in the area. The acupuncture points along the face, eye, and teeth must be carefully selected.  The three branches of the meridian should be treated separately:

1.       Ophthalmic nerve branch. This is the top branch of the trigeminal nerve.  Acupuncture points include the EX-HN4 Yu Yao, GB 1 Tong Zi Liao, SJ 23 Si Zu Kong, EX-HN5 Tai Yang and UB1 Jing Ming.  The needles should be inserted in 0.3 to 0.5 inches deep.  The patient should feel a stimulation similar to an electric shock. Continue to twist the needles three to five times, and then put the needles on the electrical stimulating machine for 30 minutes.

2.       Maxillary nerve branch. Use the St 2 Si Bai and St 1 Chen Qi points and the manipulation described above.

3.       Mandibular nerve branch. Use the St 7 Xia Guan, Ren24 Cheng Jiang and St 4 Di Chang points and the manipulation described above.

In addition, choose some body points such as GB40 Qiu Xu, Li v 5 Li Gou, LI 4 He Gu, Lu 7 Lie Que, etc. in order to adjust the energy of the entire body.

Stimulating these above acupuncture points can improve the energy flow and decrease the pain sensation signals that the trigeminal nerve sends to the brain.  The acupuncturist must ensure that the patient feels an electrical shock sensation from the needles.  This treatment allows the energy to go to the trigeminal nerve to improve the energy flow and decrease the pain.

Sharon was treated with a combination of Treatments # 2 and # 3 plus electrical stimulation of the acupuncture needles three times a week for three weeks.  After the first visit, she felt better and reported getting a good night’s sleep for the first time in six weeks.  After four weeks of treatment, the pain had subsided by 80%; thus, the treatments were decreased to once a month; after six months on this schedule, the patient told me he felt no more pain.

In my experience, the treatment of this illness has two facets.  First, there must be a clear diagnosis.  In Sharon’s case, the dentist was wrong in the evaluation of the condition, and pulled two teeth unnecessarily. It is also necessary to combine western medicine with TCM in this case, and to treat all three of the nerve branches, if necessary.  If the treatment is done properly, the patient’s pain should subside and he/she should be able to function normally in day-to-day life.

Tips for acupuncturists:

  1. You should combine the local points with the distal points for your treatment.
  2. Electrical stimulation is very important.
  3. Do not use moza in these kinds of cases.

Tips for patients:

  1. Seek for medical attention as early as possible.
  2. An ice-cold massage at the above points might decrease the pain.

 

13: Acupuncture and Occipital Neuralgia

Jan 25, 2010   //   by drxuacupuncture   //   Blog, Case Discussions, Uncategorized  //  No Comments

Dear Patients and Friends:

Happy New Year!

In the New Year, we all are facing a stressful time with new challenges because of the economy. You may sometimes have neck pain, headaches and/or poor sleep, etc. One of the possible causes of the aforementioned list might be occipital neuralgia. Please read the following case discussion; you may have some idea about it.

You are welcome to send the news letter to your friends as long as it is not for commercial use.

Best,

Jun Xu, M.D. and Hong Su, C.M.D.


News Letter, Vol. 2 (1), January, 2010, © Copyright

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

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

Rehabilitation Medicine and Acupuncture Center

1171 East Putnam Avenue, Building 1, 2nd Floor

Greenwich, CT 06878

Tel: (203) 637-7720

 

 

Case Discussion 13: Occipital Neuralgia


 

 

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

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

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

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

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

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

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

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

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

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

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

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

Tips for acupuncturists:

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

Tips for patients:

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

12: Acupuncture and Cervical Dystonia

Dec 24, 2009   //   by drxuacupuncture   //   Blog, Case Discussions, Uncategorized  //  No Comments

Dear Patients and Friends:

Happy Holidays!

Year 2009 will be ending soon. We wish everybody happy holidays and a prosperous 2010.

Please find the following news letter 12. We hope you will enjoy to read it.

Dr. Jun Xu recently started to take photos; one is attached here. We hope to hear your comments.

Happy Holidays and Happy New Year!

Best,

Jun Xu and Hong Su


News Letter, Vol. 1 (12), December, 2009, © Copyright

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

www.rmac.yourmd.com;

www.drxuacupuncture.co

Rehabilitation Medicine and Acupuncture Center

1171 East Putnam Avenue, Building 1, 2nd Floor

Greenwich, CT 06878

Tel: (203) 637-7720

Cervical Dystonia

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

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

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

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

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

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

Tests and diagnosis:

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

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

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

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

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

Medications:

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

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

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

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

4.Carbamazepine is an anticonvulsant.

Botox injections:

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

Other treatments:

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

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

Chinese medicine:

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

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

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

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

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


The patient was treated with acupuncture at the above points for approximately two months, three times a week. After the last treatment, the number of neck contractions had significantly decreased. Now, she only experiences mild neck jerks and contractions, allowing her to perform her daily activities in a normal manner.

Tips for acupuncturists:

1.Acupuncture cannot treat all forms of cervical dystonia. The milder the disease, the better the treatment results.

2.Using heating pads and massages after the acupuncture treatment increases its
effectiveness.

Tips for patients:

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

2.Help yourself with massage and heating pad.

11: Acupuncture and Drug Abuse

Nov 27, 2009   //   by drxuacupuncture   //   Blog, Case Discussions, Uncategorized  //  No Comments

Dear Patients and Friends:

I assume that all of  you are having a wonderful holiday season. Please find the following News Letter 11. We will discuss about drug abuse. It might give you some idea to help others.

I wish you continue to have a wonderful holiday season.

Best,

Jun Xu, M.D., and Hong Su, CMD., L. Ac.


News Letter, Vol. 1 (11), November, 2009, © Copyright

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

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

Rehabilitation Medicine and Acupuncture Center

1171 East Putnam Avenue, Building 1, 2nd Floor

Greenwich, CT 06878

Tel: (203) 637-7720

 

 

 

 

Drug Abuse

 

Peter W. is a 53 year old man who has been extremely successful in business. During his career, he built up a huge company which he sold for 20 million dollars in 2000.  Afterward, he felt depressed and realized he had nothing to do which made him sluggish and without motivation, as he had no goal to pursue.  He started using drugs, including heroin, which soon became a daily habit.  When he was no longer to procure drugs easily in the United States, he turned to the internet and started ordering drugs by E-mail, which were sent to him from Africa.  Though he had no real idea what he was using, he continued with his habit, which made him feel empty, depressed, anxious, restless and gave him insomnia, all of which caused a poor relationship with his wife and family.  On some occasions he used so heavily he was unable to rise from his bed for a couple of days, on other occasions his family had to rush him to the emergency room.  He felt occasional euphoria, followed by the deepest depression, and cloudy mental functioning.

He knew this was not way to live, so he tried to find work that would engross him.  For example, he took a charity job and helped the company build up cheap laptop computers for distribution to third world countries to help the young people there.  In spite of this worthwhile work, he still felt empty.  He took another job as V.P. and a seat on the Board of Directors in one of the biggest computer companies.  He worked very hard at this new job, however, as soon as he stopped working or had leisure time he found himself reverting to drug use.

Finally, he came to me for help, saying he wanted to quite drugs altogether.

Heroin is a highly addictive, illegal drug, the most abused and most rapidly acting of the opiods.  It is processed from morphine and naturally occurring substance extracted from the seeds of certain varieties of poppy plants.   It usually appears as white or brown powder, and sometimes is mixed with sugar and other substances to cut its strength.

Heroin has both long and short term effects.  The short term effects include: depression, bad respiration, clouded mental functions, nausea, vomiting, spontaneous abortion.  It is used medicinally for the suppression of pain, though under controlled conditions. In addition, heroin can cause temporary feelings of euphoria.  Long term effects include addiction and infectious diseases such as HIV, AIDS, hepatitis B and C, collapsed veins, bacterial infection, abscesses,  arthritis and pneumatic problems.

In Western medicine there are many types of detoxification programs.

  1. The methadone is the most popular.  Methadone is a synthetic opioid that blocks the effects of the heroin and eliminates withdrawal symptoms; this method has a proven record of success for heroin addicts.
  2. A pharmaceutical approach is the use of buprenorphine as another behavioral therapy.  Buprenorphine offers less risk than methadone and can be prescribed in the doctor’s office.  Bupherorphine and Suboxone is a combination drug product formulated to minimize abuse.

Chinese medicine and acupuncture have a long history of treating drug abuse.  The two types of treatments are:

  1. Auricular acupuncture
  2. Body acupuncture.

The main functions of the acupuncture treatment are to decrease the withdrawal symptoms and improve the patient’s depression and brain function.  There are many studies supporting these treatments and the most well known is that acupuncture can directly increase the level of endogenous endorphin, which makes the patient feel calm, relaxed and cheerful.  Acupuncture can also directly stimulate the central nervous system to make the patient feel less depressed and lessen the craving for drugs.

For auricular acupuncture, I use the lung, endocrine, liver, spleen and large intestine points corresponding to these organs. .  The lung has an opening through the nose and when people abuse heroin, the lung point will protect the lung function and strengthen the immune system.   The endocrine points increase endorphin secretion and increase people’s immune function to protect the entire body.  Liver and spleen points improve circulation and also improve the taste in the mouth because the spleen and stomach have openings in mouth and large intestine points; the intestine and the lung have direct meridian connection, so if we improve the function of the large intestine, this in turn will directly improve the lung function.

Pic 6-1

For the body acupuncture points, the most important ones are on the head. I use Baihui DU20 plus shi sheng chong Exn1, total five points, which can directly stimulate the central nervous system when I add electrical stimulation to the needles.  They send current directly to the cortex of the brain, which greatly improves the patient’s mood and decreases the depression.  Shuaigu GB8, which is on the head 1.5 inches above the tip of the auricular is directly connected to the sensory cortex, which will improve the body’s sensation and make it dislike the taste of heroin.  Hegu L14 is a point that can largely increase endorphin secretion and Qu Chi L111 will give a better functioning effect.  Neiguan Pc6 is a point of the pericardium meridian, which also helps improve mental functions.  Lu7 is the point from the lung meridian which protects the lung from attacks of heroin and improves the immune function of the lung.

Pic 6-2

After treatment of two weeks, the patient started to feel decreased withdrawal symptoms and had more energy.  However, he sometimes still feels cravings for heroin, and he has some physical weakness, with muscle spasms in his arms and legs.  He also experienced restlessness and agitation, often accompanied by insomnia.  I continued the acupuncture treatments three to four times a week for eight weeks, while also discussing the short and long term effects of heroin use and what organs would be effected and harmed by continued use.  He told me that, in spite of the withdrawal symptoms, he still felt much better with the treatments and he is happy to treat his addiction in this fashion, rather than go into a methadone program, at which point his drug use would become generally known.  By coming to me, he can be treated in private for his addiction.

Peter W. was also advised to make lifestyle adjustments and I encouraged him to work more for the charity.  He traveled to Africa and Asia to actually see and meet the people using the inexpensive computers, and what it could do to improve their lifestyles.  This experience touched him a great deal and after about 3 months of treatment he stopped using heroin entirely and is now completely clean.  His insomnia, depression, anxiety and other symptoms are much improved and he is leading a normal life again.

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