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50. Acupuncture and Facial Rejuvenation

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

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

 

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

Robert Blizzard III, DPT

www.drxuacupuncture.co

Rehabilitation Medicine and Acupuncture Center

1171 East Putnam Avenue, Building 1, 2nd Floor

Greenwich, CT 06878

Tel: (203) 637-7720

Fax: (203)637-2693

Acupuncture and Facial Rejuvenation

 

Fig 2-1

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

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

 

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

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

Skin consists of three layers:

 

 

Fig 2-2

 

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

 

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

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

 

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

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

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

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

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

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

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

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

Chinese Medicine treatment consists of the following parts:

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

 

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

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

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

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

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

What are some of the advantages of acupuncture over botox?

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

 

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

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

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

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

Fig 2-3

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

 

Fig 2-4

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

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

Fig 2-6

 

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

Fig 2-7

 

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

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

  1. Daily suggestion:

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

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

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

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

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

10. No smoking.

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

 

Fig 2-8

Topical Treatments (For your information)

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

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

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

 

 

 

 

 

 

 

49. Acupuncture and Post-Treatment Lyme Disease Syndrome

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

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

 

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

Robert Blizzard III, DPT

www.drxuacupuncture.co

Rehabilitation Medicine and Acupuncture Center

1171 East Putnam Avenue, Building 1, 2nd Floor

Greenwich, CT 06878

Tel: (203) 637-7720

Fax: (203)637-2693

 

Post-Treatment Lyme Disease Syndrome

My dear friends,

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

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

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

Jun Xu, MD

Recognize Acupuncturist as Healthcare providers

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

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

Thanks for your efforts and participating!

American TCM Society (ATCMS)

 

Fig 1-1

 

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

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

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

The main symptoms of PTLDS are listed as following,

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

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

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

 

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

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

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

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

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

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

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

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

 

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

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

 

 

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

 

 

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

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

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

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

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

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

Janet’s Treatment:

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

Tips for Patients:

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

Tips for Acupuncturists:

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

 

 

References

Reviews of human research

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

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

Non-human research

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

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

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

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

Reference resource:

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

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

 

 

48. Acupuncture and Multiple Sclerosis

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

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

 

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

Robert Blizzard III, DPT

www.drxuacupuncture.co

Rehabilitation Medicine and Acupuncture Center

1171 East Putnam Avenue, Building 1, 2nd Floor

Greenwich, CT 06878

Tel: (203) 637-7720

Fax: (203)637-2693

Multiple Sclerosis

                                                                                    americancompanioncare.com

 

 

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

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

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

Most Common Symptoms

Some symptoms of MS are much more common than others.

Fatigue

Numbness

Walking (Gait), Balance, & Coordination Problems

Bladder Dysfunction

Bowel Dysfunction

Vision Problems

Dizziness and Vertigo

Sexual Dysfunction

Pain

Cognitive Dysfunction

Emotional Changes

Depression

Spasticity

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

Speech Disorders

Swallowing Problems

Headache

Hearing Loss

Seizures

Tremor

Respiration / Breathing Problems

Itching

The Criteria for a Diagnosis of MS

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

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

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

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

Treatment

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

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

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

Steroids may be used to decrease the severity of attacks.

Medications to control symptoms may include:

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

The following may also be helpful for people with MS:

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

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

 

Evidence suggests that balance may be positively improved by:

Individual physiotherapy using facilitation and functional activities

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

Home balance training interventions

Targeted force-platform balance tasks

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

 

 

 

 

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

 

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

 

Acupuncture treatment for MS:

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

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

Jane’s Treatment:

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

 

Tips for Acupuncturists:

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

Tips for Patients:

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

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

 

47. Acupuncture and Tinnitus

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

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

 

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

Robert Blizzard III, DPT

www.drxuacupuncture.co

Rehabilitation Medicine and Acupuncture Center

1171 East Putnam Avenue, Building 1, 2nd Floor

Greenwich, CT 06878

Tel: (203) 637-7720

Fax: (203)637-2693

Tinnitus

www.reviews4you.net

Tinnitus

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

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

Types of Tinnitus

There are two types of tinnitus.

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

 

Causes of Tinnitus

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

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

 

http://www.riversideonline.com

 

www. naturalypure.com

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

 

Treatments in Western Medicine

Objective Tinnitus

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

Subjective Tinnitus

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

 

Treatments in Traditional Chinese Medicine

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

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

 

John’s Treatment

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

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

 

Tips for Acupuncturists and Patients

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

 

46. Acupuncture and Fibromyalgia

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

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

 

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

Robert Blizzard III, DPT

www.drxuacupuncture.co

Rehabilitation Medicine and Acupuncture Center

1171 East Putnam Avenue, Building 1, 2nd Floor

Greenwich, CT 06878

Tel: (203) 637-7720

Fax: (203)637-2693

Fibromyalgia

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

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

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

Causes

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

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

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

Fibromyalgia is most common among women aged 20 to 50.

Symptoms-Pain

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

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

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

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

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

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

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

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

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

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

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

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

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

For a diagnosis you need EITHER:

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

Treatment

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

The first type of treatment may involve:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Acupuncture treatment for Fibromyalgia

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

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

 

Helen’s Treatment:

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

Tips for patients:

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

Tips for Acupuncturists:

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

 

45. Acupuncture and Hypertension

Sep 26, 2012   //   by drxuacupuncture   //   Uncategorized  //  No Comments

News Letter, Vol. 4 (9), September , 2012, © Copyright

 

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

Robert Blizzard III, DPT

www.drxuacupuncture.co

Rehabilitation Medicine and Acupuncture Center

1171 East Putnam Avenue, Building 1, 2nd Floor

Greenwich, CT 06878

Tel: (203) 637-7720

Fax: (203)637-2693

Hypertension

 

 

 

Hypertension

William S., a sixty-two-year-old man, works as a stock analyst. His day begins at 6AM and finishes at 7PM. His lifestyle is very stressful, but he is a regular exerciser, running five miles on Saturday and Sunday. He has no health problems, save that he smokes about half a pack of cigarettes a day and has been drinking coffee for thirty years. One morning, on awakening, he felt a sudden onset of weakness and numbness on the left side of his face and arm, as well as in his left leg, and he had a moderate headache. He had difficulty walking and called his wife who noted his speech was slurred. She called an ambulance and he was rushed to the emergency room where his blood pressure was found to be 160/100. A CT scan showed blood in his brain, so William was diagnosed with a hypertensive hemorrhagic stroke. He had emergency open-scalp surgery and the blood clot was removed from his brain, but after the surgery he felt the left side of his face drooping and there was weakness in his left arm and leg.

After three months of intensive physical therapy, his symptoms improved, but he asked his doctor how, considering that he eats right and exercises, he could have suffered a stroke. He did mention to the doctor that he had not been checked for hypertension for five years, though he and his wife had availed themselves of the free blood-pressure monitor at their local supermarket.

The doctor put him on two different antihypertensive medications and told him he needed to have his blood pressure checked yearly by his physician. For a correct blood pressure reading, the doctor advised him that the readings should be taken three times, at least a week apart, and then the numbers should be averaged.

 

Hypertension—a Leading Cause of Strokes

Hypertension is high blood pressure and it is one of the main causes of a stroke. A person can have high blood pressure for years without knowing it because high blood pressure usually has no symptoms, though occasionally headaches may occur. During this asymptomatic period, hypertension can do damage to multiple organs, such as the heart, the blood vessels, the kidneys, or the brain. For this reason, it is referred to as a silent killer because suddenly one day the hypertensive person has a stroke, or develops coronary heart disease, i.e. heart attack or kidney failure.

The following comprise the rule of thumb on how to accurately and effectively take blood pressure.

  • Blood pressure should be taken at least one hour after caffeine, thirty minutes after smoking or strenuous exercise, and without any stress present.
  • The person should be upright in a chair with both feet flat on the floor for a minimum of five minutes prior to taking a reading.
  • Some people feel nervous on seeing doctors, a fairly common phenomenon known as white coat syndrome. To avoid this, the person getting the reading should be in a relaxed situation in an isolated room. Also, to counteract any discrepancy and assure an accurate result, three blood pressure readings should be taken at least five minutes apart and the results should then be averaged.
  • Older people who are suspected of having orthostatic hypotension should be given initial measurements in both arms. And in order to obtain the correct blood pressure readings, this should be done in lying, sitting, and standing blood positions.

 

Definition of Hypertension (HTN)

Based on the U.S. National Heart, Lung, and Blood Institute 2003 guidelines, blood pressure is defined as follows.

  • For adults age eighteen and above, normal systolic blood pressure is less than 120 mmHg, and diastolic blood pressure is less than 80 mmHg.
  • Pre-hypertension systolic is 120–139, with diastolic is between 80–89.
  • Stage 1 hypertension is between 140–159 systolic, with diastolic between 90 and more than 99.
  • Stage 2 hypertension is more than 160 systolic, with diastolic more than 100.

Table 9.1

Classification of Blood Pressure (BP) for Adults:

BP Classification Systolic BP mmHg Diastolic BP mmHg Lifestyle Modification
Normal <120 <80 Encourage
Prehypertension 120–139 80–89 Yes
Stage 1 HTN 140–159 90–99 Yes
Stage 2 HTN > or = 160 > or = 100 Yes

Sources: 7th Report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7), 2003

 

The Two Major Forms of Hypertension

Essential or Primary Hypertension

Ninety-five percent of those with hypertension exhibit essential or primary symptoms. Essential hypertension indicates that either no specific medical cause can be found to explain the person’s condition or that it might be caused by multiple factors. Those combined effects are responsible for HTN in approximately 72 million Americans.

Secondary Hypertension

This accounts for 5 percent of those with hypertension. In this instance, the high blood pressure is secondary to a specific abnormality, as for example kidney disease or tumors, adrenal adenoma, or other endocrine tumors.

 

Identifiable Causes of Hypertension

  • Sleep apnea
  • Drug induced (or related) causes
  • Chronic kidney diseases
  • Primary aldosteronism (adrenal gland overproduction of the hormone aldosterone)
  • Renovascular disease
  • Chronic steroid treatment
  • Cushing’s syndrome (hormone disorder caused by high level of cortisol in blood)
  • Adrenal gland tumor (pheochromocytoma)
  • Narrowing (coarctation) of the aorta
  • Thyroid or parathyroid disease

 

How Western Medicine Investigates Newly Diagnosed Hypertension

A physician will try to identify possible causes of secondary hypertension and seek evidence of end-organ damage to the heart, eyes, or kidneys.

Damages to Target Organs—Heart

  • Muscle thickening (hypertrophy) in left ventricle, the heart’s main pumping chamber
  • Angina or prior myocardial infarction
  • Heart failure

Damages to Other Target Organs

  • The brain: A stroke or a transient ischemic attack
  • The kidneys: Chronic kidney disease
  • The arteries: Peripheral artery disease
  • The eyes: Damage to the retina of the eye (retinopathy)

Main Blood Tests Performed to Determine Causes and Results of HTN

Renal function. Creatinine test to identify any underlying renal disease as a cause of hypertension, as well as it causing the onset of kidney damage. In the meantime, a baseline needs to be set up to monitor the possible side effects of certain antihypertensive drugs on the kidneys.

Electrolytes, including sodium, potassium, calcium, chloride.

Glucose to identify diabetes mellitus.

Cholesterol to identify the possible cause of coronary artery disease.

Urine samples. A healthcare provider might take urine samples to check for proteinuria in order to find out if there is any underlying kidney disease or evidence of hypertensive renal damage.

EKG for evidence of any damage to the heart.

Chest x-ray to check for signs of cardiac enlargement.

 

A recent survey found that 30 percent of those with hypertension were not aware they had it; 41 percent did not receive any antihypertensive treatment; and only 34 percent of those surveyed had it under proper control.

 

Prevention of Hypertension

Prevention of damage related to high blood pressure is the most important issue, and lowering blood pressure to prevent end-organ damage to the retina, kidney, heart, or brain is crucial. The following prevention procedures are recommended by National Institute of Health and W.H.O.

  • Weight reduction and regular aerobic exercise, such as walking, running, swimming, or bicycling. Several studies indicated that lower-intensity exercise may be more effective in lowering blood pressure than higher-intensity exercise.
  • Reducing sodium in the diet decreases blood pressure in about 33 percent of people.
  • Reducing sugar intake also helps.
  • Quitting smoking and decreasing alcohol consumption to a minimum.
  • Adopting the DASH (Dietary Approaches to Stop Hypertension) eating plan, which is rich in potassium and calcium, with reduced dietary sodium.

Lifestyle Modifications

Modifying lifestyles can reduce blood pressure, enhance antihypertensive efficacy, and decrease cardiovascular risk. As an example, a 1600 mg sodium eating plan has effects similar to single drug therapy. Combinations of two or more lifestyle modifications can achieve even better results.

Table 9.2

The Benefits of Lifestyle Modifications in Managing Hypertension

Modification Recommendation Benefits
Weight reduction Maintain normal body weight (mass index 18.5–24.9) If you can lose 10 Kg, you may be able to lower your blood pressure about 5–20 mmHg
Adopt DASH eating plan Consume a diet rich in fruits, vegetables, and low-fat dairy products with a reduced content of saturated and total fat If you adopt this plan, you may be able to lower your blood pressure about 8–14 mmHg
Dietary sodium reduction Reduce dietary sodium intake to no more than 100 mmol per day (2.4g sodium or 6g sodium chloride) If you adopt this modification in your diet, you may be able to lower your blood pressure about 4–9 mmHg
Physical activity Engage in regular aerobic physical activity, such as brisk walking at least thirty minutes per day most days of the week If you adopt this plan, you may be able to lower your blood pressure about 2–4 mmHg
Moderation of alcohol consumption Limit consumption to no more than 2 drinks (1 oz or 30 ml ethanol, 24 oz beer, 10 oz wine, or 3 oz 80 proof whiskey) per day in most men, and to no more than 1 drink per day in women and lighter weight people If you adopt this modification, you may be able to lower your blood pressure about 2–4 mmHg

Sources: 7th Report of the Joint National Committee on the Prevention,Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7), 2003

 

Pharmaceutical Treatment of Hypertension

There are many people who are currently using pharmaceutical drugs, such as angiotensin-converting enzyme inhibitors (ACE inhibitors), angiotensin receptor blockers (ARBs), beta-blockers, calcium channel blockers, and thiazide type diuretics.

Diuretics of the thiazide type have been the basis of antihypertensive therapy in most outcome trials. In many studies, a diuretic works much better than other antihypertensive medications. Therefore, in the United States, the thiazide-type diuretic is the first choice to treat hypertension.

Table 9.3

Commonly Used Drugs

Class Name (Trade Name) Usual dose range in mg/day Usual Daily Frequency
Thiazide diuretics Chlorothiazide (Diuril) 125–500 1–2
Loop diuretics Furosemide (Lasix) 20–80 2
Potassium-sparing diuretics Amiloride (Midamor)Triamterene (Dyrenium) 5–1050–100 1–21–2
Aldosterone receptor blockers Spironolactone (Aldactone) 25–50 1
Angiotensin converting enzyme inhibitors Lisinopril (Prinivil, Zestril†)Quinapril (Accupril) 10–4010–80 11
Angiotensin II antagonists Irbesartan (Avapro)Losartan (Cozaar) 150–30025–100 11–2
Beta-blockers Atenolol (Tenormin) 25–00 1
Calcium channel blockers—Dihydropyridines Amlodipine (Norvasc) 2.5–10 1
Calcium channel blockers—non-Dihydropyridines Diltiazem extended release 180–420 1

Sources: 7th Report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7), 2003.

Thiazide-type diuretics should be used alone or in combination with one of the other classes, such ACE inhibitors, angiotensin receptor blockers, beta-blockers, or calcium channel blockers.

The Goal of Antihypertensive Therapy

The ultimate public health goal of antihypertensive therapy is the reduction of high blood pressure and cardiovascular disease. The aim of treatment for most people should be getting blood pressure readings to <140/90 mmHg, and even lower in certain contexts, such as diabetes or kidney disease (some medical professionals recommend keeping levels below 120/80 mmHg).

Achieving Blood-Pressure Control

Most people who are hypertensive will require two or more antihypertensive medications to achieve their blood-pressure goals. An additional second drug from a different class should be initiated when the use of a single drug in inadequate doses fails to achieve the blood-pressure goal. When the blood pressure is more than 20/10 mmHg above the goal, consideration should be given to initiate therapy with two drugs, either as separate prescriptions or in fixed dose combinations. However, the likelihood of a dramatic decline in blood pressure leading to dizziness when people attempt to stand (orthostatic hypotension), must be mentioned, as it can occur in people who have diabetes, or in older people and there could be a dysfunction of the autonomic nervous system that regulates unconscious body functions, including blood pressure and heart rates.

 

Treatment for Hypertension in Traditional Chinese Medicine—Acupuncture

There is a thousand year history of acupuncture treatment for different symptoms of hypertension, but there is no word in Chinese history for hypertension. The hypertension diagnosis is always found where there are symptoms of dizziness, faintness, strokes, and headaches. In recent studies, it was shown that acupuncture treatment can be an excellent adjunct to medical treatment, especially for those who are diagnosed with prehypertension or stage 1 hypertension, even stage 2 hypertension. In these instances, acupuncture might greatly decrease the dosage of antihypertensive medications, and also decrease the side effects of these medications. I do not, however, recommend discontinuing antihypertensive medications and using acupuncture as the only treatment.

In traditional Chinese medicine, hypertension is manifested as following two types.

Excessive Liver Yang

The person usually shows dizziness, tinnitus, and headaches, sometimes emotional upset, anger, facial redness, insomnia, and vivid dreams or nightmares. The treatment should be focused on lowering the excessive liver yang.

  • The points should be liver UB 18 Gan Shu, Liv 3 Tai Chong, Xia Xi, UB 23 Shen Shu, GB 20 Feng Qi, Li 4 He Gu, and Li 11 Qu Qi.
  • Sp 6 San Yin Jiao, PC 6 Nei Guan, and Zu Ling Qi are sometimes added.

Table 9.4

Points Meridian Number Conditions Helped
1 Gan Shu UB 18  Backache, blurred vision, epilepsy, jaundice, mental disorders, night blindness, redness of the eye, spitting blood
2 Tai Chong Liv 3  Headaches, dizziness and vertigo, insomnia, congestion, swelling and pain of the eye, depression, uterine bleeding, retention of urine, epilepsy
3 Xia Xi GB 43  Headaches, dizziness and vertigo, tinnitus, deafness, swelling of the cheek, pain in the breast, fever
4 Shen Shu UB 23  Asthma, blurred vision, deafness, diarrhea, dizziness, swelling, impotence, irregular menstruation, low back pain, nocturnal emissions, tinnitus, weakness of the knee
5 Feng Chi Gallbladder 20  Headaches, vertigo, insomnia, pain and stiffness of the neck, blurred vision, glaucoma, red and painful eyes, tinnitus, convulsion, epilepsy, infantile convulsions, common cold, nasal obstruction
6 He Gu Li 4 
7 Qu Chi Li 11 
8 San Yin Jiao Sp 6 
9 Nei Guan PC 6 
10 Zu Ling Qi GB 41  Headaches, vertigo, pain in the breast, irregular menstruation, pain and swelling of the back of the foot, spastic pain of the foot and toe

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

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

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

Figure 9.1

 

Deficiency of Blood and Qi (Energy)

The person very often feels dizziness and faintness; the dizziness is triggered by fatigue and always becomes worse when getting up from a sitting position. This deficiency is always accompanied by a pale face, and sometimes heart palpitations, insomnia, fatigue, slowed speech, and poor appetite. The treatment for this condition should be focused on nourishing the qi and blood and improving the function of the spleen and stomach. The acupuncture points for this are the following.

  • UB 20 Pi Shu, St 36 Zu San Li, Du 20 Bai Hui, Ren 6 Qi Hai, Li 3 Zhang Men, Shen Ting and Li 4 He Gu.
  • For an acute hypertensive crisis, Extra Point Tai Yang, Du 20 Bai Hui, and St 40 Fen Long can be used.
  • Some studies show that by piercing extra points of Tai Yang and Yin Tang with slight bleeding the blood pressure will usually drop quickly.
  • If there is a severe headache in the forehead, UB 2 Zan Zhu is used.
  • If the headache is on the top of scalp, Du 20 Bai Hui and Extra Point Si Shen Chong are added.
  • If there is neck pain with stiffness, GB 20 Feng Qi is used.
  • If there is dizziness accompanied with tinnitus, St 8 Tou Wei is also added.

Table 9.5

Points Meridian Number Conditions Helped
1 Pi Shu UB 20 
2 Zu San Li St 36 
3 Bai Hui Du 20 
4 Qi Hai Ren 6 
5 Zhang Men Li 3
6 Shen Ting Du 24  Anxiety, epilepsy, headache, insomnia, palpitations, runny nose, vertigo
7 Feng Long St 40 
8 Tai Yang Extra Point  Headaches, eye diseases, deviation of the eyes and mouth
9 Yin Tang Extra Point 
10 Zan Zhu UB 2 
11 Si Shen Chong Extra–HN 1 
12 Feng Chi GB 20 
13 Tou Wei St 8 

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

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

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

 

Figure 9.2

 

Fig 9.3

 

Fig 9.4

 

Treatment for William

William was diagnosed with excessive liver yang and underwent my treatment. After three months, his blood pressure became stable and under control, and only minimum dosages of the antihypertensive drugs were used.

 

Hypertentsion Tips for Use at Home or Office

  • Be calm and relaxed. Do not add stress on top of your blood pressure.
  • Massaging Tai Yang and Bai Hui will usually help you decrease your headache and your blood pressure. Acupressure the points with your thumb or knuckle, pressing with comfortable pressure on the points; count to 20, then change to another point.
  • After the blood pressure comes down, maintenance with acupuncture is necessary once a week in the short term, and is also very useful and effective in the long run.

 

44. Acupuncture and Irritable Bowel Syndrome-IBS

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

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

 

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

Robert Blizzard III, DPT

www.drxuacupuncture.co

Rehabilitation Medicine and Acupuncture Center

1171 East Putnam Avenue, Building 1, 2nd Floor

Greenwich, CT 06878

Tel: (203) 637-7720

Fax: (203)637-2693

Irritable Bowel Syndrome—IBS

 

 

Irritable Bowel Syndrome (IBS)

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

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

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

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

 

Treatments in Western Medicine

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

 

Treatments in Traditional Chinese Medicine

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

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

                                                                      Table 8-1

 

  Points Meridian Number Conditions Helped
1 Zhong Wan Ren 12

 

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

 

2 Guan Yuan Ren 4

 

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

 

See Table 13.3
4 Gong Sun Sp 4

 

See Table 18.1

Please refer to the accompanying Figures (illustrations) for the

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

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

the acupuncture points.

 

Figure 8.1

 

 

Fig 8.2

 

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

Figure 8.3

 

Table 8.2

  Points Meridian Number Conditions Helped
1 Da Chang Shu UB 25

 

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

 

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

 

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

 

See Table 12.1
5 Qu Qi LI 11

 

See Table 12.2
6 Nei Ting St 44

 

See Table 18.1

Please refer to the accompanying Figures (illustrations) for the

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

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

the acupuncture points.

 

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

 

Table 8.3

  Points Meridian Number Conditions Helped
1 Gan Shu UB 18

 

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

 

See Table 18.1
3 Qi Men Li 14

 

Acid regurgitation, depression, hiccups
4 Tian Shu St 25

 

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

 

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

 

See Table 13.3
7 Qi Hai RN 6

 

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

Please refer to the accompanying Figures (illustrations) for the

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

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

the acupuncture points.

 

Figure 8.4

 

Lucy’s Treatment

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

 

Tips for Personal Use

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

 

 

43. Acupuncture and Insomnia

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

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

 

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

Robert Blizzard III, DPT

www.drxuacupuncture.co

Rehabilitation Medicine and Acupuncture Center

1171 East Putnam Avenue, Building 1, 2nd Floor

Greenwich, CT 06878

Tel: (203) 637-7720

Fax: (203)637-2693

 

Insomnia

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

 

Types and Causes of Insomnia

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

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

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

Most Common Reasons for Insomnia

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

 

Treatments in Western Medicine

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

Non-Medicinal Treatments and Behavioral Therapy

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

Medication

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

 

Treatments in Traditional Chinese Medicine

Chinese medicine indicates five types of insomnia.

Excessive Fire in the Heart and Liver

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

Table 7.1

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

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

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

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

 

Figure 7.1

 

 

Figure 7.2

 

Fig 7.3

 

 

Fig 7.4

 

 

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

Overeating

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

Table 7.2

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

Please refer to the accompanying Figures (illustrations) for the

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

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

the acupuncture points.

 

Fig 7.5

 

Depression and Sadness with Deficiency of Lung Energy

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

Table 7.3

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

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

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

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

 

Fig 7.6

 

 

 

Fig 7.7

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Disharmony of the Heart and Kidney

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

Table 7.4

Points Meridian Number Conditions Helped
1 Sheng Shu UB 23

See Figure 14.1See Table 14.42Tai XiKidney 3

See Figure 16.6See Table 16.23Sheng MenHeart 7

See Figure 20.2See Table 20.24An MianEx HN13

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

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

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

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

 

Deficiency of Qi (Energy) and Blood

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

Table 7.5

Points Meridian Number Conditions Helped
1 Pi Shu UB 20

See Figure 7.8 2Sheng ShuUB 23

See Figure 7.8 3San Yin JiaoSpleen 6

See Figure 7.9 3Sheng MenHeart 7

See Figure 20.2 4An MianEx HN13

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

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

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

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

Fig 7.8

 

 

Fig 7.9

 

 

 

 

Alice’s Treatment

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

 

Tips for Personal Use at Home

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

 

42. Acupuncture and Postchemotherapy Syndrome

Jun 24, 2012   //   by drxuacupuncture   //   Blog, Case Discussions, Uncategorized  //  No Comments

 News Letter, Vol. 4 (6), June  , 2012, © Copyright

 

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

Robert Blizzard III, DPT

www.drxuacupuncture.co

Rehabilitation Medicine and Acupuncture Center

1171 East Putnam Avenue, Building 1, 2nd Floor

Greenwich, CT 06878

Tel: (203) 637-7720

Fax: (203)637-2693

          

Postchemotherapy Syndrome Treatment

Alleviating Amanda’s Chemotherapy Symptoms

Amanda W. is a forty-five-year-old woman who was diagnosed two years ago with stage 3A cancer symptoms in her left breast. She was screened by a mammogram and an ultrasound, which found a tumor about one inch across on her on her left breast, with five positive lymph nodes under her left arm. She had a mastectomy on the left side, with clearance of the lymph nodes under the left arm. She also was given chemotherapy for about three months. After chemotherapy, Amanda complained of nausea, vomiting, diarrhea, and a change of taste in her mouth; she also felt very weak and fatigued. She experienced hair loss and poor concentration, with occasional numbness and tingling on the tips of her finger and toes, and came to me for help in relieving or decreasing these multiple side effects of her chemotherapy.

Breast Cancer Statistics

In the United States, breast cancer is the second most common type of cancer among women. And among women worldwide, after non-melanoma skin cancer, breast cancer is the most common form of cancer. It is the number-one cause of cancer death in Hispanic women, and is the second most common cause of cancer death in white, black, Asian/Pacific Islander, and American Indian/Alaska Native women.

In 2005 (the most recent year numbers are available):

  • 186,467 women and 1,764 men were diagnosed with breast cancer;1,2
  • 41,116 women and 375 men died from breast cancer.1,2

Risk Factors for Breast Cancer

The key to preventing breast cancer is knowing the risk factors and practicing self-screening. The following risk factors might increase your chances of developing breast cancer:

  • Age. The older you are, the higher the chance that you can develop breast cancer. In women over sixty, there is usually a higher chance of breast cancer than in women under sixty.
  • A previous history of breast cancer.
  • Family history. If a mother, sister, or daughter had breast cancer, or if breast cancer runs anywhere in your family, the risk is higher than for the average woman.
  • Gene changes. If you have the BRCA1or BRCA2 genes, you will probably have a higher chance of developing breast cancer.
  • Reproductive history. The older a woman is when she had her first child, the greater her chances of developing breast cancer will be.
  • Women without children are at increased risk of breast cancer.
  • If you got your first menstrual period before age twelve, there is an increased risk for breast cancer.
  • If you became menopausal after age fifty-five, there is an increased risk of breast cancer.
  • Menopausal women using hormone therapy with estrogen plus and progestin after menopause are at increased risk of breast cancer.
  • Race. White women have a higher chance of developing breast cancer than darker-skinned women.
  • Breast density. The higher the density of breast tissue, the higher the chance of breast cancer.
  • Overweight or obese women have a higher chance of breast cancer.
  • Lack of physical activity leads to a higher chance of breast cancer.
  • Alcohol consumption in immoderate amounts leads to a higher chance of breast cancer.

Screening Mammograms

A mammogram is a picture of the breast made with x-rays. The National Cancer Institute recommends the following:

  • Women in their forties and older should have a mammogram every one to two years.
  • Women who are younger than forty and who have risk factors for breast cancer should ask their healthcare provider whether to have mammograms and how often to have them.

If a mammogram is positive, the following procedures might be recommended.

  • Ultrasound. This will identify if the lump is a fluid-filled cyst or a solid mass.
  • An MRI. This will give a detailed picture of the breast tissue.
  • Needle biopsy, core biopsy, and surgical biopsy.

Stages of Breast Cancer

Here are the stages of breast cancer.

  • Stage 0 is carcinoma in situ. Abnormal cells are in the lining of a lobule or in the lining of a duct.
  •  Stage 1 is 2 cm or smaller and has not spread outside the breast.
  • Stage 2 is one of the following: The tumor is no more than 5 cm, with or without it spreading to the lymph nodes under the arm.
  • Stage 3 is locally advanced cancer. It is divided into stages 3A, 3B, and 3C.

According to the United States Cancer Statistics 2005 from the Centers For Disease Control and Prevention, the following statistical data showed the chances of cancer for American men and women. (The numbers in parentheses are the age-adjusted—U.S. standard—rates per 100,000 people.) http://www.cdc.gov/Features/CancerStatistics/

Cancer Among Men

The three most common cancers among men include:

  • Prostate cancer (142.4): First among men of all races.
  • Lung cancer (84.6): Second among men of all races.
  • Colorectal cancer (58.2): Third among men of all races.

The leading causes of cancer death among men are:

  • Lung cancer (69.4): First among men of all races.
  • Prostate cancer (25.4): Second among white (22.7), black (54.1), American Indian/Alaska Native (18.0), and Hispanic (18.7) men.
  • Liver cancer: Second among Asian/Pacific Islander men (14.5).
  • Colorectal cancer (21.0): Third among men of all races.

Cancer Among Women

The three most common cancers among women include:

  • Breast cancer (117.7): First among women of all races.
  • Lung cancer (55.2): Second among white (56.6), black (50.9), and American Indian/Alaska Native (37.6) women, and third among Asian/Pacific Islander (26.9) and Hispanic (25.2) women.
  • Colorectal cancer (41.9): Second among Asian/Pacific Islander (32.2) and Hispanic (33.9) women, and third among white (40.8), black (49.4), and American Indian/Alaska Native women (24.5).

The leading causes of cancer death among women are:

  • Lung cancer (40.6): First among white (41.6), black (40.2), Asian/Pacific Islander (18.2), and American Indian/Alaska Native (29.2) women, and second among Hispanic women (14.4).
  • Breast cancer (24.0): First among Hispanic women (15.1), and second among white (23.3), black (32.9), Asian/Pacific Islander (12.3), and American Indian/Alaska Native (15.3) women.
  • Colorectal cancer (14.6): Third among women of all races.

Racial or Ethnic Variations

  • American Indian/Alaska Native men have the lowest incidence rates of cancer; however, Asian/Pacific Islander men have the lowest death rates from cancer.
  • White women have the highest incidence rates of cancer; however, black women have the highest death rates from cancer.
  • American Indian/Alaska Native women have the lowest incidence rates of cancer and the third-highest death rates from cancer.

Treatment in Western Medicine—Chemotherapy

Many cancers are treated with chemotherapy IV in their various stages. Therefore, different side effects will accompany the chemotherapy. The main organ or tissues of the human body that may be affected by chemotherapy doses are where normal cells rapidly divide and grow, such as the lining of the mouth, the digestive system, skin, hair, and bone marrow. After a treatment period longer than six months, your nervous system will be affected as well, and the symptoms of this, including poor concentration, decreased memory, peripheral polyneuropathy, and tinnitus, might appear. Long-term side effects can also include weight gain, loss of fertility, menopause, and secondary cancer, such as leukemia.

Short-Term Side Effects of Chemotherapy

  • In the digestive system, some chemotherapy drugs can cause nausea and vomiting, even diarrhea, sometimes a sore mouth or mouth ulcers, changes in taste in the mouth and tongue, and changes in smell.
  • Chemotherapy can affect the blood stem cells in the bone marrow. The bone marrow stem cells will divide into three different types of blood cells.
    • Red blood cells, which carry oxygen to all parts of the body. If the red blood cell numbers are decreased, then the transportation of oxygen around the body will slow down and the person will develop anemia and feel very tired and lethargic. Sometimes she/he may feel shortness of breath, or feel dizzy and lightheaded because there is less oxygen being carried around the body.
    • White blood cells, which are essential to the immune function for fighting infection and monitoring mutation, among other things. If your white blood cells counts are decreasing, the immune function will decrease and there will be an increased chance of infection.
    • Platelets, which help the blood clot and control bleeding. If your platelet counts are decreasing, you have a high chance of bruising and you may have a nosebleed or may bleed more than usual from minor cuts or bruises.
  • Hair loss: Some chemotherapy can damage the hair and make it brittle or thin, and some chemotherapy can make all of the hair fall out, usually a few weeks into treatment. The body, pubic, and underarm, hair may be lost as well. However, if your hair does fall out due to chemotherapy, it will grow back over a few months once your chemotherapy is finished.
  • Skin and nail changes. Skin may become very dry and discolored and more sensitive to sunlight. Nails may grow very slowly or become brittle or flaky.

Long-Term Side Effects of Chemotherapy

  • Chemotherapy’s effects on peripheral nerves: Some drugs can cause peripheral polyneuropathy, which is a sensation of tingling, numbness, and pins and needles in your hands or feet. This neuropathy will affect your ability to detect hot or cold objects, which could lead to burns or frostbite, and it can also decrease your sensitivity to the steps you take, which could lead to a fall.
  • Chemotherapy’s effects on the central nervous system: Long-term use of chemotherapy may cause poor concentration, decreased memory, tinnitus, anxiety, restlessness, dizziness, sleepiness, or headaches.
  • Chemotherapy’s effects on the kidneys: It can change the kidney function and lead to water retention, loose protein in the urine, or increased BUN and creatinine levels. In order to prevent kidney deterioration, intravenous fluid must be given for several hours before the treatment, and the kidney’s functions must be checked before and after each chemotherapy treatment.
  • Secondary cancer is another long-term side effect of chemotherapy: Many different types of secondary cancer, such as leukemia, can occur.
  • Chemotherapy’s effects on fertility: Some chemotherapy treatments may cause infertility. For women, it can sometimes bring on symptoms of menopause and temporarily or permanently stop the ovaries from producing eggs. For men, some chemotherapy drugs may reduce the number of sperm, or affect the sperm’s ability to reach and fertilize a woman’s egg during intercourse. Some drugs may also, temporarily or permanently, affect the sex life.

Treatment for Chemotherapy in Traditional Chinese Medicine—Acupuncture

Traditional Chinese medicine can help with many, but not all, of chemotherapy’s side effects. The acupuncture treatments listed below can be helpful with some side effects of chemotherapy.

Gastrointestinal (GI) symptoms

Gastrointestinal symptoms include nausea, vomiting, gastric regurgitation, tenderness or fullness of the stomach, abdominal pain with very bad breath, also hiccups, diarrhea, and constipation.

  • For nausea and vomiting, Zhong Wan, Zu San Li, Nei Guan, He Gu, and Feng Chi are used.
  • If a person feels hot and thirsty, it is good to add Da Zhui, Jin Jing, and Yu Ye.
  • If the person has bad breath, Xia Wan and Nei Ting are added.
  • If there is vomiting of clean water and the person experiences dizziness, Feng Long, Tan Zhong, and Gong Sun are added.
  • For hiccups, Ge Shu, and Ju Que are used. If they are accompanied by diarrhea, Ta Chang Shu, Shen Shu, and San Ying Jiao are added.
  • For constipation, Feng Long, left Shui Diao, and the left Gui Lai are used.

Table 6.1

Points Meridian Number Conditions Helped
1 Zhong Wan Ren 12

See Table 13.32Nei GuanPC 6

See Table 16.13Zu San LiSt 36

See Table 13.34Feng ChiGB 20

See Table 12.15He GuLI 4

See Table 12.16Da ZhuiDu 14

See Table 12.17Jin JingExtra HN 12

See Table 26.48Yu YeExtra HN 13

See Table 26.49Xia WanRen 10

Abdominal pain, diarrhea, indigestion, vomiting10Nei TingST 44

See Table 29.111Feng LongSt 40

See Table 13.312Tan ZhongRen 17

See Table 14.413Gong SunSp 4

See Table 21.114Ge ShuUB 17

Vomiting, hiccups, belching, difficulty swallowing, asthma, coughing, spitting up blood, afternoon fever, night sweats, measles15Ju QueRen 14

See Table 16.116Da Chang ShuUB 25

See FigureSee Table 19.217San Yin JiaoSp 6

See Table 16.118Shui DaoSt 28

See Table 26.1119Gui LaiSt 29

See Table 26.11

Please refer to the accompanying Figures (illustrations) for the

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

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

the acupuncture points.

Figure 6.1


Fatigue

Chemotherapy can lead the person to feel fatigue, and have shortness of breath, weakness, difficulty walking or standing, heart palpitations, or insomnia.

  • The acupuncture points will be Pi Shu, Wei Shu, Zhong Wan,and Zu San Li.
  • For heart palpitations and insomnia (poor sleep), Xin Shu, Sheng Men, Ju Que, and San Yin Jiao are added.
  • If the person feels cold, has weakness of the lower back and legs, Bui Hui, Da Zhui, Sheng Shu, and Guan Yuan are added.
  • If the person feels hot or annoyed, has trouble sleeping, then Fei Shu, Tai Xi, San Yin Jiao are added.

Table 6.2

Points Meridian Number Conditions Helped
1 Pi Shu UB 20

See Table 15.22Wei ShuUB 21

See Table 31.13Zhong WanRen 12

See Table 13.34Zu San LiSt 36

See Table 13.45Xin ShuUB 15

See Table 16.16Sheng MenHeart 7

See Table 29.17Ju QueRen 14

See Table 16.18San Yin JiaoSp 6

See Table 16.19Bai HuiDu 20

See Table 22.410Da ZhuiDu 14

See Table 12.111Shen ShuUB 23

See Table 14.412Guan YuanRen 4

See Table 30.113Fei ShuUB 13

See Table 13.114Tai XiKid 3

See Table 16.2

Please refer to the accompanying Figures (illustrations) for the

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

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

the acupuncture points.

Menopause and Loss of Fertility

Many people undergoing chemotherapy have impotence, decreased menstruation or menopause, and low libido, accompanied by dizziness, tinnitus, weakness in the low back and knees, and they always feel cold and have insomnia. The treatment is Sheng Shu, Guan Yuan, Qi Men, Zhi Gong, San Yin Jiao, and Zu San Li.

Table 6.3

Points Meridian Number Conditions Helped
1 Shen Shu UB 23

See Table 14.42Guan YuanRen 4

See Table 30.13Qi MenLiver 14

See Table 19.34Zi GongExtraordinary Point

Prolapse of the uterus, irregular menstruation5San Yin JiaoSp 6

See Table 16.16Zu San LiSt 36

See Table 13.3

Please refer to the accompanying Figures (illustrations) for the

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

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

the acupuncture points.

Hair Loss

After chemotherapy, many people will have hair loss. Acupuncture can be used to help with this, mainly body acupuncture.

  • Tai Xi and Xue Hai, Sheng Men, Feng Chi, Qu Qi, and He Gu.
  • Plum Blossom needle, a cluster of 7–9 needles grouped together with a long handle, can be can be used for the hair loss, gently tapping on the scalp until the skin shows slightly redness or mild bleeding. The plum blossom should be used on alternative days, tapping on the scalp for about twenty minutes. After three or four weeks of treatment, the hair will start to grow gradually, especially in those areas that have lost a patch of hair.

Table 6-4

Points Meridian Number Conditions Helped
1 Tai Xi Kid 3

See Table 16.22Xue HaiSp 10

See Table 30.13Shen MenHeart 7

See Table 29.14Feng ChiGB 20

See Table 12.15Qu QiLI 11

See Table 12.26He GuLI 4

See Table 13.1

Please refer to the accompanying Figures (illustrations) for the

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

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

the acupuncture points.

Effects on the Central Nervous System (CNS)

After chemotherapy, some people may feel such CNS symptoms as poor concentration, loss of memory, tinnitus, insomnia, nightmares, headaches, or fatigue.

  • Acupuncture points for these symptoms will be Zu San Li, Nei Guan, He Gu, Sheng Men, San Ying Jiao, Feng Chi, as well as Bai Hui, Tang Yang, and Tou Wei.
  • Another important treatment uses Plum Blossom needles around the cervical, thoracic, and lumbar spine, along the urinary bladder meridians. This is done by tapping from the top and going down three lines following the urinary bladder meridians. Normally, these treatments will greatly improve a person’s concentration, memory, and mental function.

Table 6.5

Points Meridian Number Conditions Helped
1 Zu San Li St 36

See Table 13.42Nei GuanPC 6

See Table 16.13He GuLI 4

See Table 12.14Shen MenHeart 7

See Table 29.15San Yin JiaoSp 6

See Table 16.16Feng ChiGB 20

See Table 12.17Bai HuiDu 20

See Table 22.48Tai YangExtra Point

See Table 22.29Tou WeiSt 8

See Table 22.3

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

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

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

Peripheral Polyneuropathy

The long-term side effects of chemotherapy can gradually damage the peripheral nerves. The person may symptomatically feel numbness and a tingling sensation on both the hands and the feet, and may also experience burning, sharp pins and needles along them. The treatments will depend on the location of the condition.

  • For the upper extremities, Jian Yu, Jian Liao, Qu Chi, He Gu, Tian Jing, Chi Zhe, and Da Ling, Yang Xi, Wan Gu, Yang Chi, and Wai Guan are used.

Table 6.6

Points Meridian Number Conditions Helped
1 Jian Yu LI 15

See Table 26.12Jian LiaoSJ 14

Pain and motor impairment of the shoulder and upper arm3Qu ChiLI 11

See Table 12.24He GuLI 4

See Table 12.15Tian JingLJ 10

Migraine, pain in the neck, shoulder, and arm, epilepsy6Chi ZheLu 5

See Table 13.27Da LingPC 7

Cardiac pain, convulsions, epilepsy, foul breath, insomnia, irritability, mental disorders, palpitations, stomach ache, stuffy chest, vomiting8Yang XiLI 5

Headaches, redness, pain and swelling of the eye, toothache, sore throat, pain of the wrist9Wan GuSI 4

Headaches, rigidity of the neck, pain in the wrist, jaundice10Yang ChiSJ 4

Pain in the arm, shoulder and wrist, malaria, deafness, thirst11Wai GuanSJ 5

See Table 12.2

Please refer to the accompanying Figures (illustrations) for the

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

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

the acupuncture points.

Figure 6.2

  • For the lower extremities, Huan Tiao, Chi Bian, Cheng Fu, Yang Ling Quan, Du Bi, Liang Qiu, Zu San Li, Kun Lun, Tai Xi, Jie Xi, Qiu Xu, Sheng Mai, and Zao Hai are used.

Table 6.7

Points Meridian Number Conditions Helped
1 Huan Tiao GB 30

See Table 26.72Chi BianUB 54

See Table 26.23Cheng FuUB 36

Bloody stools, diarrhea, dysentery, hemorrhoids, impotence4Yang Ling QuanGB 34

See Table 15.35Du BiSt 35

Pain, numbness, and motor impairment of the knee6Liang QiuSt 34

Pain and numbness of the knee, gastric pain, motor impairment of the lower extremities7Zu San LiSt 36

See Table 13.38Kun LunUB 30

See Table 22.19Tai XiKid 3

See Table 16.210Jie XiSt 41

Pain of the ankle joint, muscular atrophy, motor impairment, pain and paralysis of the lower extremities, epilepsy, headaches, dizziness, and vertigo, abdominal distension, constipation11Qiu XuGB 40

See Table 32.212Sheng MaiUB 62

See Table 29.213Zhao HaiKid 6

Irregular menstruation, prolapse of uterus, urinary retention, constipation, epilepsy, insomnia, sore throat, asthma

Please refer to the accompanying Figures (illustrations) for the

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

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

the acupuncture points.

Figure 6.3

Figure 6.4

Treatment for the Side Effects of Amanda’s Chemotherapy

As you read from the above, Amanda had one of the common side effects of chemotherapy. I first treated her symptoms of pain, depression, and anxiety, with the above-mentioned methods and they are getting better. Then I tried to treat her GI symptoms and fatigue. Although her treatment with me was on, off, and regular, because she was busy going for chemotherapy a few times a week, after my treatments, she feels her appetite is better and her fatigue is much improved. I also treated the numbness and tingling sensation in her hands and toes for about three months, but it proved the most difficult problem to solve as she still felt numbness and tingling after the three months, so she was advised to come to my office once a week to maintain her treatment. The treatments were successful and she finally feels the numbness and tingling has been reduced. Additionally, her energy has been restored enough that she has been able to return to a regular schedule for her work and family life.

Tips to Use at Home or Office

  • Acupuncture cannot cure cancer. Please be aware of the limitations of acupuncture in this respect.
  • However, acupuncture can help a good deal with the side effects of chemotherapy. It is therefore worthwhile to try if you have gastrointestinal symptoms, fatigue, hair loss, infertility, CNS-related problems, or polyneuropathy after chemotherapy.

41. Acupuncture and Bell’s Palsy

May 23, 2012   //   by drxuacupuncture   //   Blog, Case Discussions, Uncategorized  //  No Comments

News Letter, Vol. 4 (5), May  , 2012, © Copyright

 

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

Robert Blizzard III, DPT

www.drxuacupuncture.co

Rehabilitation Medicine and Acupuncture Center

1171 East Putnam Avenue, Building 1, 2nd Floor

Greenwich, CT 06878

Tel: (203) 637-7720

Fax: (203)637-2693

 

Bell’s Palsy

Bell’s Palsy

Joan S, a forty-five-year-old woman, awoke one morning to find that when she brushed her teeth she felt numbness on the left side of her face. Her left eye was dry and she had difficulty closing it, plus her mouth tasted odd and she could not hold water in it. When she realized she was drooling, and began to feel that the left side of her face was paralyzed, she immediately called her husband who arranged for an ambulance to take her to the hospital, where she was given a CT scan and an MRI of the brain. The results showed she had not suffered a stroke, but during the physical examination she felt dizzy and realized she was again drooling out the left side of her mouth. She had a dry mouth, her left facial muscles were twitching, she was hypersensitive to sound, and she had developed slurred speech. The doctors diagnosed her condition as Bell’s Palsy and gave her a corticosteroid patch for ten days, decreasing the dosage daily. When there was no improvement after the ten-day treatment, she consulted her primary care physician who prescribed acyclovir, which was supposed to prevent further damaging of the facial nerve.

After a week of acyclovir, she still felt no improvement, so she returned to this same doctor and he said her symptoms should disappear spontaneously within three to six months. After three months of no improvement, she became extremely frustrated with her condition. She still felt numbness on the left side of her face and had difficulty closing her eyes and mouth, which were both drooping; she was drooling and could not smile using the left side of her mouth. Once again back with the same doctor, he advised her that things should right themselves if she gave it more time. At this point, Joan started to feel scared, so she asked around and was referred to me by her friends.

Joan’s condition, Bell’s Palsy, is a form of temporary facial paralysis resulting from damage or trauma to cranial nerve VII, one of the two facial nerves. This paralysis causes muscle distortion and interferes with such facial functions as closing the eyes, eating, and using one side of the mouth. The onset of Bell’s Palsy is usually sudden—many people wake up one morning to discover that one side of their face is paralyzed. Sometimes the symptoms are confused with a stroke, but Bell’s Palsy is definitely not a stroke, it is only due to injury to the cranial nerve VII.

Functions of Cranial Nerve VII

  • Cranial nerve VII has many nerve fibers, which are distributed to the scalp, the face, and the facial muscles. It supplies some of the salivary glands, which provide lubricants to the eyes and mouth and is responsible for sensations to the hearing organs—the ear canal and behind the ear.
  • Its nerve fibers affect the forehead and the upper eyelids, including eyebrow elevation, forehead wrinkling, frowning, and tight closing of the eyes.
  • Its nerve fibers in the lower face include showing the teeth, whistling, puffing the cheeks, and having a natural smile; it is also responsible for impulses to two-thirds of the tongue, including the ability to taste.

See the figure 5-1

 

fbr.org

Discovery, Symptoms, and Causes of Bell’s Palsy

The disease is named for Sir Charles Bell, a Scottish surgeon who discovered the nerve and its effects on the facial muscles about 200 years ago. It affects about 40,000 people in the United States each year, and is most commonly seen in young adults.

Many people think it is an inflammation and swelling of the facial nerve that leads to an the onset of Bell’s Palsy. This condition can be triggered by a virus infection, such as chicken pox, herpes simplex, herpes zoster, HIV, mononucleosis, or mumps, or by a bacterial infection, such as Lyme disease or tuberculosis. Others believe that brain-stem tumors, skull fractures, or neurological conditions, such as diabetic neuropathy or Guillain-Barré syndrome, can lead to Bell’s Palsy.

The most common symptoms are the sudden onset of paralysis or weakness of one side of the face, with difficulty closing the eyes, facial droop and difficulty with facial expressions, pain behind or in front of the ear with an amplification of sounds on the affected side, headache, loss of taste, and changes in the amount of tears and saliva.

 

Treatments in Western Medicine

The treatment of Bell’s Palsy is controversial in Western medicine; many people are given no treatment and are expected to recover spontaneously.

Some Western doctors prescribe the following treatments.

  • Medications. The one most usually prescribed is a corticosteroid, sometimes mixed with antiviruses, such as acyclovir, which are expected to help in recovery.
  • Physical therapy. It is believed that physical therapy can relax the strain in the facial muscle and prevent the symptoms from recurring.
  • Surgery. Surgery is very controversial. If the facial paralysis has not recovered after 6 months, a person can manifest many symptoms, including drooping eyes and difficulty closing them, and distortion and spasms of the facial muscles. Although such surgical procedures as facial nerve repair, facial nerve graft, facial nerve substitution, and muscle transposition are not able to completely restore normal function, they can significantly improve the face’s appearance and ability to function.

In Joan’s case, her primary care doctor thought medication alone would be sufficient treatment, so she waited three of the six months he suggested without becoming better. It was at this point that she decided to consult me.

 

Treatments in Traditional Chinese Medicine

Traditional Chinese medicine believes that facial paralysis is due to wind invasion. The wind attacks the facial nerve and causes nerve and muscle paralysis. Because the nerve supplies the impulses to the facial muscle, the taste buds, and the eye, paralysis causes muscle dysfunction and makes treatment of acupuncture at the appropriate points most important. And the sooner treatment starts, the better. It is not good to wait six months, or even three, as Joan did, to see if there is a spontaneous recovery; it is best to start treatment immediately because the viability of the facial nerve decreases every day. Even after six months, there is still a good chance of recovering from the paralysis, but instead of waiting that long, it is better to treat the affected person as soon as possible.

People with Bell’s Palsy are almost always nervous about their condition, and feel extremely stressed, believing their symptoms could be the signs of a stroke. For this reason, the acupuncture treatment should not only treat the paralysis, but also utilize points intended to relieve stress.

The following points used for this condition are locally selected—most of them are on the face.

Yang Bai penetrating Yu Yao, and Si Bai, Tai Yang penetrating Xia Guan, Di Chang penetrating Jia Che, Ying Xiang, Zhuan Zhu, Cheng Jian, Feng Chi, Yi Feng, and He Gu.

Table 5.1

Points Meridian Number Conditions Helped
1 Yang Bai GB 14See Figure 27.1 Frontal headaches, eye pain, vertigo, twitching or drooping eyelids, tearing up
2 Yu Yao Ex-HN 4See Figure 27.1 Pain above the eye, twitching or drooping eyelids, cloudiness of the cornea, redness, swelling, and pain in the eye
3 Si Bai St 2See Figure 27.1 Redness, pain, and itching of the eyes, facial paralysis, twitching eyelids, pain in the face
4 Tai Yang Ex-HN 5See Figure 15.2 See Table 15.2
5 Xia Guan St 7See Figure 26.9 See Table 26.3
6 Di Chang St 4See Figure 26.9 See Table 26.3
7 Jia Che St 6See Figure 26.9 See Table 26.3
8 Ying Xiang LI 20See Figure 27.1 Nasal obstruction, smell impairment, itching and swelling of the face
9 Zan Zhu UB 2See Figure 27.1 Headaches, blurred and failing vision, pain in the ridge above the eye, tearing, redness, swelling and pain of the eye, twitching of eyelids, glaucoma
10 Chen Jiang Ren 24See Figure 27.1 Facial puffiness, swelling of the gums, toothache, salivation, mental disorders
11 Feng Chi GB 20See Figure 22.4 See Table 22.1
12 Yi Feng SI 17See Figure 25.1 See Table 25.1
13 He Gu LI 4See Figure 12.2 See Table 12.1

Please refer to the accompanying Figures (illustrations) for the

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

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

acupuncture points.

Figure 5.2

 

 

Joan’s Treatment

Joan was treated with the above acupuncture points, which helped supply the blood flow to the nerve and decreased the muscle spasms and inflammation. She also received massages, and after one month of these treatments she completely recovered from Bell’s Palsy.

 

Tips for People with Bell’s Palsy

  • I cannot stress enough the importance of treatment as soon as possible; waiting is not an option.
  • Daily massages, 20 minutes per session and 3 sessions per day, combined with the above acupuncture points, will greatly help recovery. Acupressure the points with your thumb or knuckle, pressing with comfortable pressure on the points; count to 20, then change to another point. You should work symmetric points at the same time.
  • Tips for acupuncturists:

    1. Mainly put needles on the paralyzed side, however, you also have to put a few needles on the healthy side, which will help the energy flow go through the paralyzed side.
    2. After acupuncture treatment, massage for about 10 to 15 minutes will greatly help the patient’s recovery.
    3. Most of the time, your patients will get 90% to 100% recovery, again, the earlier the treatment, the better the results.

 

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