Browsing articles in "Uncategorized"

60. Dr. Xu’s New Book: The Praeger Handbook of Acupuncture for Pain Management A Guide to How the “Magic Needles” Work

Oct 23, 2014   //   by drxuacupuncture   //   Uncategorized  //  1 Comment

This unique text examines 30 specific pain management case studies to explain pain treatments from the perspectives of Eastern acupuncture and traditional Chinese medicine as well as that of Western medical practice.Millions of Americans are affected or incapacitated by a wide variety of chronic pain—from heel spurs, herniated discs, and hip bursitis to osteoarthritis, plantar fasciitis, and rotator cuff tears. As complex as the injuries and problems can be, medically speaking, for many pain sufferers, the question is simple: can acupuncture work to make my pain go away? This book provides information from 30 different pain management cases to shed light on the effectiveness of acupuncture treatments in specific situations.

Presented in easy-to-understand, plain language, the author explains why acupuncture works to stop pain from the theoretical frameworks of both traditional Chinese medicine and Western medicine. Each chapter describes the potential sources and systems of specific pain, depicts the acupuncture points for that pain, and explains how they work. The case studies—selected from more than 9,000 patients seen by Dr. Xu during his 14 years of clinical practice in the United States—document how acupuncture has effectively granted these individuals relief from pain, whether viewed from the Western science of neurology, or the Eastern theories of yin and yang and keeping the body’s energies in a balanced state.

Features

  • Presents information and experience from a unique physician: a licensed, board-certified medical doctor and acupuncturist with extensive training in both the United States and China
  • Illustrates acupuncture and acupressure points with specific detail useful to both patients and acupuncturists
  • Provides a dual-purpose self-study book that enables acupuncturists to better diagnose pain and guides patients on performing self acupressure pain treatment

59. Frozen Shoulder and Acupuncture Treatment

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

News Letter, October, 2014, © Copyright

 

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

James Olayos, DPT, CSCS

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

Rehabilitation Medicine and Acupuncture Center

1171 East Putnam Avenue, Building 1, 2nd Floor

Greenwich, CT 06878

Tel: (203) 637-7720

 

Frozen Shoulder and Acupuncture Treatment

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

 

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

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

 

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

Fig. 1

 

 

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

Frozen shoulder is usually exhibited in three stages:

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

 

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

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

 

Western medicine treatments:

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

 

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

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

Physical Therapy Treatment for Frozen Shoulder:

 

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

Fig. 2

 

Fig. 3

 

 

Fig. 4

 

 

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

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

 

 

Traditional Chinese Medicine Treatment:

 

The following points were selected:

 

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

 

Table 1

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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Fig. 5

 

 

Fig. 6

 

 

Fig. 7

 

 

Fig. 8

 

 

 

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

 

 

Tips for acupuncturists:

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

Tips for patients:

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

58. Severe Neck Pain and Acupuncture Treatment

Sep 10, 2014   //   by drxuacupuncture   //   Uncategorized  //  No Comments

News Letter, September, September 2014 , © 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

 

 

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 teres

FCR

EDC

Triceps brachii

Paraspinals

Triceps brachii Elbow extension Middle finger
C8/T1 C7 Triceps

Brachii

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 Experienced

Points

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 joint

See 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 ulna

See 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.

57. Headaches and Acupuncture Treatment

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

News Letter, August, 2014, © Copyright

 

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

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

Rehabilitation Medicine and Acupuncture Center

1171 East Putnam Avenue, Building 1, 2nd Floor

Greenwich, CT 06878

Tel: (203) 637-7720

 

Intolerable Headache

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

 

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

 

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

Tension headache:

 

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

 

 

 

 

 

Cluster headache:

 

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

 

 

 

 

 

 

 

 

 

Migraine Headache:

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

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

 

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

The causes of headaches are usually different.

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

 

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

 

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

 

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

 

Chinese medicine classifies headaches into two categories:

 

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

 

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

 

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

 

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

 

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

 

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

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

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

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

 

Acupuncture treatment for headaches:

 

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

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

 

Figure 1

Figure 2

Figure 3

 

Figure 4

 

Figure 5

Figure 6

 

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

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

 

 

 

 

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

 

 

 

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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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

 

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

 

 

 

 

 

.

 

 

 

 

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

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

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

 

 

 

 

 

 

 

 

 

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

 

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

 

 

 

 

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

 

 

 

 

 

 

 

 

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

Acupressure tips for patients:

 

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

 

Acupuncture Tips for Practitioners:

 

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

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

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

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

56. Unexplained Infertility with Acupuncture treatment

Jul 16, 2014   //   by drxuacupuncture   //   Uncategorized  //  No Comments

News Letter,© 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

Case Discussion 1:

Unexplained Infertility

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

For the male:

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

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

3.
The testes system, including transportation and maturation.

For the female:

1.
Fallopian tube damage or blockage.

2.
Endometriosis.

3.
Ovulation disorders.

4.
Early menopause.

5.
Polycystic ovary syndrome.

6.
Fibroid in the uterine.
Even though there are many women who cannot conceive because of the above reasons, there are also 15 % of couples who cannot conceive due to unexplained reasons, and Amy falls into this category.
Amy was encouraged to have IVF treatment and, beforehand, get acupuncture treatments. She was scheduled to have hormone regulation (hormone treatment) for a month before trying to become pregnant again, and to have acupuncture treatments with me three times a week during that month.
Two groups of key acupuncture points were selected for Amy:
Zhong Ji (Ren # 3), Guan Yuan (Ren # 4), Gui Lai (Stomach # 29), Chong Men (Spleen # 12), and Fushe (Spleen # 13). This group of acupuncture points adjusts the hormonal level of the entire body. Zhong Ji and Guan Yuan (Ren # 3 and Ren # 4) directly stimulate the uterus, which makes the uterus muscle very relaxed, and will increase the chance of contraception and easy implantation. Stimulation of the point Fushe (Spleen 12), and Chongmen (Spleen 13)—both points bilateral and adjacent to the ovary and uterus—will directly adjust the ovary’s hormonal secretion cycle, in turn increasing the activity of the pituitary, adrenal and ovary axis and increasing the chance of contraception. Gui Lai (Stomach 29) is also adjacent to the ovary and uterus, which assists the first four points in adjusting the entire female hormone system.


The second group is on the back eight-liao points.


Eight-liao points (eight points on both sides of the sacral area) directly stimulate the pudendal nerve and the pelvic splanchnic nerve. These nerves will stimulate the uterus and ovaries and help increase the chance of contraception, as well as adjust the entire hormonal system of the female reproductive system.


The two groups above of key acupuncture points will be alternatively treated during each day’s visit, in addition to the Hegu Large Intestine # 4, Quchi Large Intestine # 11, San Yin Jiao Spleen # 6, Xue Hai Spleen # 10 and Tai Chong Liver # 3 – all of which will help adjust the hormone environment in the entire body and thus aid contraception.
After four weeks of treatment, Amy underwent the IVF procedure and was kept on the acupuncture treatment twice a week. Amy reported to me that she had eight eggs mature, an improvement from the first IVF treatment which had produced only three mature eggs.
After a 48 to 72 hour culture, six of her eggs were fertilized and Amy’s doctor implanted four into the uterus. The doctor told her she should have bed rest overnight and that she could return to work the next day; however, I told her to have bed rest for two days, because Amy’s job is more stressful than most people’s, and she has to bend forward in her work to deliver babies.
A month after insemination Amy told me she was pregnant. She was very excited about her condition and eight months later delivered twins, a boy and a girl. She was thrilled with the results, as was her husband.
In my personal experience:

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

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

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

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

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

According to studies from Germany and Australia, the IVF treatment without acupuncture has a 29% success rate for pregnancy. However, the combination of acupuncture with IVF increases the success rate to 49%–almost a third higher than IVF alone. Therefore, it would seem advisable to combine the two treatments.

 

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.

 

 

53. My Africa Medical Trip

Jun 29, 2013   //   by drxuacupuncture   //   Uncategorized  //  No Comments

My Africa Trip – An Unforgettable Experience

Jun Xu, MD,  June 29, 2013

My Dear Patients and Friends,

As many of you may know, I went to West Africa for medical mission trip with my son, Jimmy Xu, a medical student, Elizabeth Cooper, my office administrator, Nataliya Kushta, my physical therapy assistant and 8 other non-medical personnel from a local church in Bridgeport between May 18 and June 2, 2013.  This trip  has changed our life, opened our eyes to see the poverty, ignorance, corruption and the needy vividly.  I would like to share with you about my period of life, which is embedded with fire and tears. This report is a little long,  please bear with me.  It will be greatly appreciated if you could finish reading my report.  Pic. 1

With the help of the local churches in US and Africa,  we went to two countries,  Senegal and  Guinea Bissau, traveled around 800 miles, stayed in three cities, Dakar, Kedougou in Senegal and Bissau in Guinea Bissau. Here is the borderline between Senegal and Guinea Bissau. Pic. 2.

For 400 miles on one trip between the two countries, we went through 19 check points like this. They checked our passports and we paid different amount of fee. For some reasons,  the fee was negotiable, because the governments  often do not pay their employees, therefore, the officers have to make money from us. Here was one of the check points. Pic. 3

We bought hams, chicken, cheese from Costco, freeze them, and brought to Africa with this blue ice box. Most of the 15 days, we ate the sandwich from the ice box.  Pic. 4

We have seen total 2,420 patients,  we treated 450 patients in one day once, which exhausted our energy. The average patients we have seen are around 300 per day. The most common complaints  are fever, diarrhea, cough and skin issue. About 65% patients are children.  Here was the patients who were waiting to be attended. Pic 5.

We collected cash donations from my patients and friends for total $18,083.00. We spent around $4,000 for  antibiotics and saved $14,000 for the  future use. All my team members paid our  own travel expenses including air fare, local transportation, room and food. We brought about $50,000 worth of medicine donated from Americares,  an organization  based  in Stamford, CT, Henry Schein, a medical supply company in NY, and 6 organizations. We had no difficulty getting the medicine through the Senegal Customs,  however, Delta Airline fined us $500 for overweight. Pic. 6

We went to 10 different villages. We stayed in a leprosy village for 2 days. The following photo was a patient with active leprosy wound and amputation. Pic. 7

Here was a child with active leprosy wound. Pic 8.

We set up a tent in the leprosy village, another small tent was put inside the tent, the temperature was around 120F, therefore, we were unable to check the body temperature of patients. As long as the patients complained of fever, we would give out antibiotics to treat their infections.  Pic. 9

One day, our team members were eating lunch, there were many children surround us. After we threw all the bones of chicken, beef, and pork into a garbage can,  the children picked up the bones and started to eat.  Pic. 10

My heart was broken, we gave  the children our lunch, they grabbed the food with their unwashed hand. Pic. 11.

This child was crying when he ate, he may not eat this kind of food for one to two months as the local people told me.  Pic. 12.

Most of the patients were very ignorant but some of them were very sly and shrewd. One day I saw a chief of the leprosy village, he claimed he had hypertension, I agreed to give him medicine “Benicar” 20mg once a day for 30 days. He returned on the second day with an empty package and told me that he took all the medicine. I was amazed that his blood pressure was not dropped to zero.  Afterwards, I realized I was so naïve, I was told that he might hide his medicine and asked for more. I told this person to hold his empty package and took the picture. Pic. 13.

We went to a remote village to deliver medical care and food.  We took 4 wheel drive truck to cross  the jungle and river bank to the village.  Liz was climbing up the truck. Pic. 14.

Our truck was crossing the river bank. Pic. 15.

We went to the village and gave out food to the local people.   We brought to each family of  a bag of rice 50 kg and vegetable oil for total  about 310 families in different villages. Pic. 16.

The village chief is the richest man in the village and he has 4 wives, I took pictures of him and his hut.  You will see his kitchen on the right side with three stones and his bed on the left side with a luxurious mosquito tent.  Pic. 17.

Here was the inside hut. Pic. 18

Here was one of his 4 wives and her children. Pic. 19.

 

I think the education is the most important and the most urgent. I went to three schools established by Pastor Otavia, who provided free education and free lunch to more than 400 students. My heart was deeply touched. Pic. 20.

Here is another school, students were eating free lunch. Pic. 21.

The school did not provide drinks, students drunk water directly from well. Pic. 22.

Pic. 23.

After I return from Africa, my heart is broken, my blood is burning. They need help, Yours and mine.  We would like to build up a technical school in Senegal, which will teach the local students with carpentry, plumbing, electrician, craft works, etc.  We believe the school will self-run after 3 to 4 years. Here is the land we purchased. Pic. 24.

 

We need around $45,000 to start our first phase construction. Mr. Vincent Camuto, one of my patients, has already donated $10,000 to us, which is a great help. If you would like to help our construction, please write your check to  AGWV, and mail it to my office         

Jun Xu, MD, 1171 E Putnam Avenue, Riverside, CT 06878.

Your donation will be used to the construction 100% without any administration fee. Your name will also be plagued on the wall at the entrance of the school  if your donation is more than $500 and if you are not against us to do so.  However, any amount is welcome. Your donation will make a big difference. You will also receive a US tax deductible receipt.

Thank you very much for your help! Hungary Africa people will remember your help forever!

Yours Sincerely,

 

Jun Xu, MD

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.

 

51. Acupuncture and Perimenopausal Syndrome

Mar 28, 2013   //   by drxuacupuncture   //   Uncategorized  //  No Comments

News Letter, Vol. 5 (3), March, 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 Perimenopausal Syndrome

 

 

Mary is a 48 year-old woman who complains of night sweats with poor sleep and hot flashes for last 4 months.  She also notices irregular period that sometimes is very heavy in volume.  She also notices the following symptoms of fatigue, mood swings, breast tenderness, decreased sex drive, vaginal dryness, discomfort during sex, urine leakage when coughing or sneezing along with urinary urgency.  She consulted her primary care physician and was told to have perimenopausal syndrome. She was offered to take low dose birth control pills, or maybe estrogen replacement.  She was afraid of the side effects of birth control pills and estrogen replacement, therefore, she comes to me for alternative treatment.

 

Mary has perimenopausal syndrome (PMS), which usually happens to women at age of around 45 years-old, however, each individual might have different experiences as some athletes start perimenopausal syndrome as early as 30 years-old with other women as late as age 60.

Menopause is defined as the state of an absence of menstrual periods for 12 months. The menopausal transition starts with varying menstrual cycle length and ends with the final menstrual period. Perimenopause is a term sometimes used and means “the time around menopause.” It is often used to refer to the menopausal transitional period. It is not officially a medical term, but is sometimes used to explain certain aspects of the menopause transition in lay terms.

Menopause is caused by the cessation of ovarian function.  The ovary is a pair of reproductive glands in women. They are located in the pelvis, one on each side of the uterus. Each ovary is about the size and shape of an almond. The ovaries produce eggs (ova) and female hormones such as estrogen. During each monthly menstrual cycle, an egg is released from one ovary. The egg travels from the ovary through a Fallopian tube to the uterus.

The ovaries are the main source of female hormones, which control the development of female body characteristics such as the breasts, body shape, and body hair. The hormones also regulate the menstrual cycle and pregnancy. Estrogens also protect the bone. Therefore, a woman can develop osteoporosis (thinning of bone) later in life when her ovaries do not produce adequate estrogen.

Western Medicine Treatments

Estrogen Replacement Therapy (HRT)

Estrogen replacement therapy was a widely recommended treatment for menopausal symptoms as well as in the prevention of osteoporosis and heart disease.

Systemic estrogen replacement therapy (ERT) affects your entire body and reverses the effect of low estrogen. Systemic ERT may:

  • Reduce the frequency and severity of hot flashes.
  • Improve moodiness and sleep problems related to hormone changes.
  • Maintain the lining of the vagina, reducing irritation.
  • Increase skin collagen levels, which decline as estrogen levels decline. Collagen is responsible for the stretch in skin and muscle.
  • Help prevent postmenopausal osteoporosis by slowing bone loss and promoting some increase in bone density.
  • Reduce the risk of dental problems, such as tooth loss and gum disease.

Risks of estrogen replacement therapy

Estrogen replacement therapy (ERT) may increase the risk of health problems in a small number of women. This increase in risk depends on your age, your personal risk. Using ERT may increase your risk of:

Side effects that can occur with all forms of estrogen but are more common with oral estrogen (and less common with a patch, cream, gel, or vaginal ring) include:

Some of these side effects, such as headaches, nausea, fluid retention, weight gain, and breast tenderness, may go away after a few weeks of use.

The estrogen patch (transdermal estrogen) may cause skin irritation.

An estrogen ring must be replaced every 3 months. If the ring falls out at any time during the 3-month treatment period, you may rinse it with lukewarm water and reinsert it.

Alternative Treatments

Supplements, herbs and botanicals like black cohosh, evening primrose oil, and flaxseed are thought to relieve menopausal symptoms.

Black Cohosh

Black cohosh, also known as black snakeroot or bugbane, is a medicinal root. It is used to treat women’s hormone-related symptoms, including premenstrual syndrome (PMS), menstrual cramps, and menopausal symptoms.

Wild Yam and Progesterone Creams

Wild yam and progesterone creams are available without a prescription and are marketed for relieving perimenopausal symptoms caused by “estrogen dominance.”

Soy for Menopause Symptoms

Soy is high in isoflavones. Isoflavones are a type of phytoestrogen. Phytoestrogens are chemicals found in plants that work like estrogens.

Acupuncture and Chinese Herbs

Acupuncture treatment has long been used for perimenopausal symptoms (PMS), most Traditional Chinese Medicine physicians believe kidney deficiency is the main pathological cause for PMS. Therefore, acupuncture points selection is based on the above reasoning.

    1. Main points: Ren 4 Guan Yuan, Ren 3  Zhong Ji, Ren 19 Zi Gong,  Sp 6 San Ying Jiao, Ht 7 Shen Men, Du 20 Bai Hui,  Liv 3 Tai Cong, Pc 6 Nei Guan, Ren 17 Tan Zhong, GB 29 Ju Liao, and GB28 Wei Dao.

Here are some important points that  must be used for PMS.

2. Accessory points: Kidney Yin Deficiency add points of Kid 10 Yin  Gu,  Ki 3 Tai Xi, Ki 12 Da He, UB 18 Gan   Shu;  Kidney Yang Deficiency add UB 20 Pi Shu, St 36 Zu San Li

3. Ear Needles: Main Points, kidney, endocrine, sub-cortex, plus sheng meng, jiao gan, , liver, heart, spleen, etc.

Research evidence showed that  PMS symptom was improved with decreased FSH, LF and increased E2 and endorphins level.

Acupuncture and many Chinese herb formulas have been used to effectively adjust the hormone level, the most important herbs are  Bai Sa sheng, Mai Men Dong, Dan Gui, Di Huang, Gou Ji, Chuan Lian Zi, Ye  Jiao Teng, etc.  The formula prescribed depends on the diagnostic type of Chinese Medicine,  each individual is different from other, therefore, no one formula can be used for all the  patients without modification.

Mary’s Treatment

Mary was diagnosed of kidney deficiency, therefore, The main points were selected. However, Mary’s symptom also indicated liver yin deficiency, Liv 3 Tai Cong, UB 18 Gan Shu, Kid 3 Tai Xi were added to the treatment plan. She underwent acupuncture treatment 3 x per week for 4 weeks plus Chinese herb pills 2x per day, she felt much improved with her night sweats and hot flush, she also reported better sleep and less mood swing, she was continued to have acupuncture maintenance  treatment once a week for 6 weeks, then she continued her Chinese herbs for rest of the treatment. After 4 months, she reported her symptom was almost  gone.

Tips for the patients:

  1. The earlier, the better to get your treatment.
  2. Try to use both Chinese herbs and Acupuncture treatment.
  3. If it is possible, you should drink Chinese herb tea, which should be prescribed by physician who had really training. The formula should be individualized and based on your specific need.
  4. Keep smooth mood, always relaxed, do not put too much stress on  yourself.

Tips for the acupuncturists:

  1. Chose some scalp points, such as Du 20 Bai Hui, GB 20 Feng Chi, Du 16 Feng Fu, GB 8 Shuai Gu, even Extra-point Tai Yang, will be very helpful.
  2. Try to use Chinese herbs to help, such as Gou Ji, Chuan Lian Zi, Yu Zhu, Shi Fu, let patient use them as tea.
  3. Stress reduction treatment is very important, the points in the liver meridian should be chosen, such as Liv 3 Tai Chong, Kid 3 Tai Xi, etc.

 

 

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