Browsing articles tagged with " Acupuncture"

69. Occipital Headache, How Can Acupuncture Treat It?

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

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

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

www.drxuacupuncture.co

Rehabilitation Medicine and Acupuncture Center

1171 East Putnam Avenue, Building 1, 2nd Floor

Greenwich, CT 06878

Tel: (203) 637-7720

How Can Acupuncture treat Occipital Neuralgia?

 

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

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

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

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

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

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

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

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

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

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

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

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

Tips for acupuncturists:

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

Tips for patients:

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

 

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

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

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

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

www.drxuacupuncture.co

Rehabilitation Medicine and Acupuncture Center

1171 East Putnam Avenue, Building 1, 2nd Floor

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

Cervical Dystonia




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

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

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

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

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

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

Tests and diagnosis:

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

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

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

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

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

Medications:

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

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

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

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

4.Carbamazepine is an anticonvulsant.

Botox injections:

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

Other treatments:

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

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

Chinese medicine:

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

  1. Acupuncture

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

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

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

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

  1. Moxibustion:

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

  1. Guasha (Scrape) :

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

Tips for acupuncturists:

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

Tips for patients:

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

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

 

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

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

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

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

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

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

Progression of disease

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

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

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

Leprosy village people were celebrating the opening of the clinic.

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

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

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

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

65. Eczema and Acupuncture Treatment

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

 

News Letter, Vol. 7 (2)

July, 2016 © Copyright

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

Rehabilitation Medicine and Acupuncture Center

1171 East Putnam Avenue, Building 1, 2nd Floor

Greenwich, CT 06878

Tel: (203) 637-7720

Eczema

Pic 1 Itch

 

http://www.askdrshah.com 

 

 Case History

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

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

Types of Eczema

There are multiple types of eczema, including:

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

Pic 3 Atopic eczema

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

Pic 4 contact eczema

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

Pic 5 allergic contact eczema

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

Dyshidrotic Eczema

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

Pic 6 neurodermotitis

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

Pic 7 Seborrheic dermatitis

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

Pic 8 Nummular eczema

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

Pic 9 stasis eczema

 

 

Mechanism of Eczema

Pic 2 Mechnism

 

https://nationaleczema.org/eczema/

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

Causes of eczema

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

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

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

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

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

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

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

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

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

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

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

West Medications

  1. Topical corticosteroids

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

Reduce inflammation

Tame allergic reactions

Ease irritation or soreness

Reduce itching and the desire to scratch

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

  1. Systemic corticosteroids

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

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

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

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

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

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

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

  1. Antihistamines for Eczema

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

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

  1. Light Therapy and Other Treatments

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

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

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

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

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

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

Traditional Chinese Medicines

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

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

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

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

  1. Chinese Herbs: 

1). Take by mouth: 

Three types of Traditional Chinese Medicine treatment:

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

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

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

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

The treatment course for Jack: 

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

Tips for Acupuncturists:

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

Tips for patients:

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

 

 

64. Acupuncture and Infertility Case Discussion

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

 

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

Case Discussion

Acupuncture and  Infertility

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

Rehabilitation Medicine and Acupuncture Center

1171 East Putnam Avenue, Building 1, 2nd Floor

Greenwich, CT 06878

Tel: (203) 637-7720


Baby

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

 

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

 

BBT

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

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

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

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

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

·       BBT stays high if there is a pregnancy.

 

What is this BBT chart about?

·       Follicular phase

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

 

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

 

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

  Luteal phase

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

 

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

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

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

BBT

 

Ovulation

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

 

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

 

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

BBT2

 

Conception takes time

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

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

6 Pregnancy Tips

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

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

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

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

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

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

healthy-bmi-chart

Definition of Infertility:

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

There are many causes of infertility, including the following:

For the male:

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

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

3. The testes system, including transportation and maturation.

For the female:

1. Fallopian tube damage or blockage.

2. Endometriosis.

3. Ovulation disorders.

4. Hormonal causes, such as hypothyroidism,

4. Early menopause.

5. Polycystic ovary syndrome.

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

Assistant Reproductive Technology:

1.     Intrauterine Insemination (IUI)

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

2.     In Vitro Fertilization (IVF)

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

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

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

There are 2 classes of drug used for this:

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

GnRH-antagonist such as Ganirelix or Cetrotide

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

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

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

Gonal-F, Follistim, Bravelle, Menopur

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

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

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

 B. Egg Retrieval:

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

C. Fertilization:

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

 D. Embryo Transfer:

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

Evidence of Acupuncture as an adjunct to IVF

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

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

The role of acupuncture in assisted reproductive technology.

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

 

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

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

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

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

 

The following acupuncture protocols are used to help IVF patients:

 

A.    Lupron Routine:

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

 

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

2.     Cerebrum acupoints(HP-Zone)

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

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

3.     Huatuojiaji:

 

B.    FSH Routine:

to help stimulation of multiple eggs.

1.     Cerebrum acupoints(HP-Zone)

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

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

2.     Intersection-Zone:

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

3.     Abdominal Zone:

Guanyuan (Ren 4),Zigong (EX Points)

4.     Sacrum-Zone:

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

C.    HCG Routine:

to improve the final maturation of the eggs

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

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

D.    After Egg Retrieval:

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

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

E.    For the mobility and viability of Sperm:

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

F.    Before the Embryo Transfer:

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

G.   After the Embryo Transfer:

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

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

H.    After confirmed pregnancy:

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

Some important acupuncture points:

Back PointsAbdomen

Amy’s treatment:

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

 

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

My personal experience:

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

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

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

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

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

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

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

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

Dear Friends:

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

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

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

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

Thank you very much!

Best,

 

Jun Xu, MD

Rehabilitation Medicine and Acupuncture Center

1171 E Putnam Avenue, Riverside, CT 06878

Tel:203-637-7720

59. Frozen Shoulder and Acupuncture Treatment

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

News Letter, October, 2014, © Copyright

 

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

James Olayos, DPT, CSCS

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

Rehabilitation Medicine and Acupuncture Center

1171 East Putnam Avenue, Building 1, 2nd Floor

Greenwich, CT 06878

Tel: (203) 637-7720

 

Frozen Shoulder and Acupuncture Treatment

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

 

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

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

 

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

Fig. 1

 

 

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

Frozen shoulder is usually exhibited in three stages:

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

 

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

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

 

Western medicine treatments:

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

 

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

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

Physical Therapy Treatment for Frozen Shoulder:

 

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

Fig. 2

 

Fig. 3

 

 

Fig. 4

 

 

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

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

 

 

Traditional Chinese Medicine Treatment:

 

The following points were selected:

 

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

 

Table 1

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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Fig. 5

 

 

Fig. 6

 

 

Fig. 7

 

 

Fig. 8

 

 

 

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

 

 

Tips for acupuncturists:

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

Tips for patients:

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

52. Acupuncture and Rheumatoid Arthritis

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

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

 

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

Robert Blizzard III, DPT

www.drxuacupuncture.co

Rehabilitation Medicine and Acupuncture Center

1171 East Putnam Avenue, Building 1, 2nd Floor

Greenwich, CT 06878

Tel: (203) 637-7720

Fax: (203)637-2693

 

Acupuncture and Rheumatoid Arthritis

 

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

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

 

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

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

Other signs and symptoms that can occur in RA include:

Loss of energy

Low grade fever

Loss of appetite

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

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

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

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

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

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

 

Fig. 3 RA Hand Deformity  www.eastlady.cn

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

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

Anemia (a low red blood cell count)

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

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

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

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

 

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

Fig 5.  RA hand x-ray

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

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

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

 

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

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

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

West Medicine Treatment:

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

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

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

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

Living with rheumatoid arthritis

 

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

 

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

 

Acupuncture Treatment:

 

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

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

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

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

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

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

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

Sandy’s Treatment:

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

Tips for Patients:

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

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

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

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

Tips for Acupuncturists:

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

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

 

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.

 

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