Browsing articles tagged with " Acupuncture"

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.

40. Acupuncture and Dupuytren’s Contracture

Apr 11, 2012   //   by drxuacupuncture   //   Blog, Case Discussions, Uncategorized  //  No Comments

News Letter, Vol. 4 (4), April  , 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

 

Dupuytren’s Contracture

http://www.glutenfreeforgood.com/blog/celiac-disease-and-dupuytrens-contracture

 

Luke, a seventy-two-year-old man who was born in Norway, reported that about a year ago he noticed a small lump growing along the fourth finger of his right hand that continued to the area where his palm and fourth finger meet. In the beginning, his finger felt only slightly tender; but six months later, the finger had gradually contracted and he experienced difficulty extending the finger at the metacarpal phalangeal (MCP), proximal interphalangeal (PIP), and distal interphalangeal (DIP) finger joints. Though he did not experience much pain, he did notice there was a cord of tissue under the skin of his palm that prevented him from extending his fourth finger and greatly interfered with his hand function and movement. This situation continued to develop over a year, at which point he went to his primary care physician who did not understand what was wrong with Luke’s hand. Luke was then referred to me.

In examining Luke’s hand, I found the cordlike tissue that had formed along his fourth finger and caused it to bend unnaturally towards his palm. There did not seem to be much tenderness in the area, but Luke had difficulty extending his fourth finger and coordinating it with his other fingers. He had tried massage, ultrasound, and physical therapy, including stretching exercises for the hand, but none of it helped and his symptoms were gradually getting worse, leading me to believe he had a condition known as Dupuytren’s contracture.

 

Symptoms, Causes, and Diagnosis

Dupuytren’s contracture is a very specific condition. It often affects people of Scandinavian or Northern European descent and has been called the Viking Disease, though it has also been found in Spain and the Far East.

Its primary characteristics include the following.

  • People who are older than forty are the ones most likely to develop the condition. For anyone older than forty, the disease is more common in men than in women. By age eighty, however, gender is not an important factor.
  • It is often a condition that is passed down through families.
  • It usually happens in the fourth and fifth fingers; the thumb and index fingers are almost always spared.
  • Some may contract Dupuytren’s after developing certain conditions, such as alcoholism, diabetes, epilepsy, liver disease or trauma.

Although Dupuytren’s contracture is poorly understood, many physicians and research scientists think it is caused by fibroblast proliferation and collagen deposits.

It is thought there are three stages of Dupuytren’s contracture.

1. The proliferation stage, which is characterized by the development of nodules. Many of the nodules may be located or felt at the far end of the palm’s crease.

2. The active stage, in which the cord begins to form near the nodule.

3. The residual stage, in which tendonlike cords are visible and the contraction between the palm and fingers becomes obvious.

 

Treatments for Dupuytren’s Contracture in Western Medicine

Noninvasive Treatments

It is not usually necessary to treat this condition. However, if you develop the later stage of this condition, up to the point where your finger function becomes restricted, it may be necessary to seek medical treatment.

Collagenase Injections

This treatment, currently in phase three of FDA approval, utilizes an injection of collagenase along the contracted cords. A small dosage of collagenase is best to dissolve or soften the cords.

X-Rays

Low-energy X-rays can also soften or reduce the contraction of the cords.

Physical Therapy

Warming up the area is important, first with heat, then ultrasound. Manual work on the hand can help remove restrictions, and should be followed by stretches to regain more motion.

 

Surgery

Surgery for this condition consists of opening the skin over the affected cords and removing the fibrous tissue. This procedure is not curative, however, and cannot prevent the affected wrist and palm areas from developing Dupuytren’s disease again at a later date.

After the surgery, you will most likely need further surgery to clean out the remainder of the cord in your fingers. Also be advised that the surgery comes with a risk of injury to the nerves and surrounding connective tissues.

 

Treatments for Dupuytren’s Contracture in Traditional Chinese Medicine

Acupuncture

Acupuncture is a minimally invasive technique. For this condition, the needles are inserted locally along the cords, and electrical stimulation is then added to the highest degree that can be tolerated. It lasts 25–30 minutes, and you are allowed to adjust the stimulation level yourself. This treatment is followed by 5 minutes of ultrasound to soften the cord. Finally, there is a massage and some stretching exercises, all of which together serve to decrease the rigidity of the cord.

Table 41.1

  Points Meridian/Number
1 He Gu LI 4
2 Qu Chi LI 11
3 Arshi As Fig 14.1

 

Figure 14.1

 

 

Luke’s Treatment

Luke underwent the above combination of treatments 15 times. He was also told to soak his hand in very hot water every morning for 15–20 minutes, and to massage and stretch his fourth finger. He repeated these same stretches after acupuncture treatments in my office. After 15 visits, his condition was completely resolved. This treatment routine was also successfully tried in France in 1983, with similar positive results.

 

Additional Treatments for Depuytren’s Contracture

I have treated more than thirty cases of Dupuytren’s contracture and have found that the earlier the treatment, the better the results. For example, I treated a young, twenty-five-year-old man who had a family history of Depuytren’s that had passed on to him. He had developed a nodule in his right hand at the meeting point of the fourth finger and palm. Because he consulted me at the earliest stage of his condition, I was able to cure him in only six or seven visits. If treatment is begun at a very late stage, acupuncture may not be a successful therapy.

 

Tips for People with Dupuytren’s Contracture

  • Your cooperation in the treatment procedures is very important. This includes soaking your hands in hot water for 15–20 minutes every morning and doing stetching exercises on the affected finger.
  • The results will be even better if you self-treat at home by massaging Chinese herbal massage cream or oil—red flower is good—into the affected area.

 

39. Acupuncture and Stroke

Mar 10, 2012   //   by drxuacupuncture   //   Blog, Case Discussions, Uncategorized  //  No Comments

News Letter, Vol. 4 (3), March  , 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

 

STROKE

 

 

 

 

 

 

healblog.net

William H., a seventy-year-old man with a history of hypertension and diabetes mellitus, came to my office complaining that his left arm and leg had been weak and almost paralyzed for two months. He told me that several months earlier he had experienced a sudden-onset headache. He had felt numbness and a tingling sensation in his left arm and leg, had difficulty opening both eyes, experienced double vision as well as slurred speech and dizziness, and his movements were clumsy. He was rushed to the emergency room where he was given a CT scan, which confirmed that he’d had a stroke. He was immediately admitted to the hospital and was given all possible medical treatment: anticoagulation medication, aspirin, and heparin. He remained in the hospital for a month and, upon discharge, he entered an acute rehab center where he was given exercises for his arm and leg. After a month he felt some improvement in his shoulder and hip joints, but still could not move his elbow, wrist, fingers, knee, or ankles. Finally, he consulted me for treatment.

 

Types and Causes of Strokes

Strokes usually occur in down time, and are usually heralded by all or some of these symptoms: a sudden onset of weakness or paralysis of the arms, legs, side of the face, or any part of the body. They can be accompanied by numbness and a decreased tingling sensation, with slurred speech, an inability to speak or understand someone’s else speech, difficulty reading or writing, blurred vision, difficulty swallowing, drooling, loss of balance or coordination, loss of memory, and vertigo. Some people also experience anxiety, depression, lethargy, nervous energy, or loss of consciousness. These symptoms are usually caused by a blockage in the brain artery, a narrowing of the small arteries within the brain, or a hardening of the arteries and arthrosclerosis leading to the brain.

Strokes are usually divided into three types.

  • Type 1 is ischemic stroke, caused by a blood clot that blocks blood flow to the brain.
  • Type 2 is hemorrhagic stroke, caused by bleeding inside of the brain that is secondary to ruptured aneurysms or uncontrolled high blood pressure.
  • Type 3 is a transient ischemic attack (TIA). This symptom is seen for less than twenty-four hours, after which the person recovers and becomes normal again. A TIA is a warning stroke, or mini-stroke that produces strokelike symptoms, but no lasting damage. Recognizing and treating TIAs can reduce your risk of a major stroke.

Additional causes of strokes, with the exception of strokes caused by old age or high blood pressure, are described below.

  • Coronary artery disease, which can lead to a heart attack or stroke, as can other heart conditions, such as endocarditis, fibrillation, heart failure, or heart valve diseases.
  • Diabetes, which doubles the risk of stroke.
  • High cholesterol, which causes hardening of the arteries.
  • Overweight and diet. Consumption of high-fat food and alcohol abuse can cause a stroke. Too much alcohol increases blood pressure and cholesterol levels.
  • Peripheral artery disease, such as carotid artery disease.
  • Physical inactivity.
  • Smoking, both primary and secondhand.

 

Treatments in Western Medicine

In Western medicine, strokes are treated as follows.

Ischemic Strokes

  • In an ischemic stroke the doctor must quickly restore blood flow to the brain. This emergency treatment, together with medication, usually starts with aspirin, which has proved the best treatment immediately after a stroke, and reduces the possibility of another stroke. The emergency room doctor will likely administer this treatment.
  • Two other useful drugs for treating ischemic strokes are coumadin and heparin.
  • Some who have ischemic strokes may be given tissue plasminogen activator (rt-PA), which is a potent clot-busting drug that helps some people fully recover. According to recent N.I.H. protocol, rt-PA must be injected within 3 hours after the symptoms’ onset, once brain bleeding is ruled out by CT scan and/or doctors are certain that giving a tissue plasminogen activator (TPA) will not worsen any bleeding in the brain. TPA is administered only in ischemic strokes.
  • Surgical procedures might also be used, including carotid endarterectomy, angioplasty, and stents.

Hemorrhagic Strokes Where Surgery Must be Utilized

The most common procedures for hemorrhagic strokes are clipping aneurysms and removal of an arteriovenous malformation (AVM). This is an abnormal connection between veins and arteries, usually congenital, and usually occurring in the central nervous system.

After emergency treatment, early rehabilitation is very important because the most benefit will be obtained within six months of having a stroke.

There will usually be a team of doctors and therapists to help with stroke recovery. It can consist of a dietician, a neurophysiologist, a nurse, occupational, physical, and recreational therapists, a psychiatrist, a rehabilitation doctor, a social worker, and a speech therapist. The goal of stroke rehabilitation is to help the person recover as much independence and function as possible. Much of stroke rehabilitation involves relearning the skills of daily activity, not only for the paralyzed extremities, but also for improving speech and swallowing, as well as for vision and hearing functions.

 

Treatments in Traditional Chinese Medicine

The TCM treatments for strokes are different from Western medicine, where, after emergency room treatment or surgery, the main recovery method is to try and return physical functions to the parts of the body affected by the stroke. Although this method will strengthen the muscles and increase the range of motion, the goal of TCM and acupuncture is to try and stimulate the seat of the stroke, the brain—a method that is believed to help the patient recover more quickly.

Both Western and traditional Chinese medicine recognize the same two forms of stroke: Ischemic and hemorrhagic. Acupuncture should be started as soon as possible after a stroke occurs and the person’s medical condition has been stabilized.

As illustrated in Figure 26.1A, the brain contains many different functional centers. On the motor and sensory zones, as shown in Figure 26.1B, the brain structure looks like an upside down human body, functionally represented on the cerebral cortex.

Figure 3-1

 

 

 

 

 

 

 

Explanation of Points

  • Cheirokinesthetic Center: Center for memories of movements
  • Opticokinetic CoordinatingCenter: Center for movement of the eyeballs in response to the movement of objects across the visual field
  • Motility Speech Center: Center for movements related to speech organs
  • Auditory Center: Center for primary processing of hearing; center for receiving impulses from the ear by way of the auditory nerve
  • Auditory Speech Center: Center for interpretation of sound
  • Visual Center: Center for receiving signal from eyes.
  • Visual Speech Center: Center for understanding of the written and spoken language; enables a person to read a sentence, understand it and say it out loud
  • Sensory Center: Center for entire body’s sensation
  • Motor Center: Center for entire body’s movement

 

Figure 3-2

B illustrates the location of movement of the body’s entire trunk and four limbs. Please refer to its motor area in Figure 3-1

During the course of more than three thousand years of accumulated experience, traditional Chinese medicine (TCM) developed scalp acupuncture, one of its most advanced treatments for people with strokes. TCM studied the relationship between the human body’s function and the anatomy of the scalp, and created systemic points on the scalp, which coincide with contemporary neuroanatomy.

Figure 3-3

 

 

Figure 3-4

 

 

Figure 3-5

 

 

The Importance of Acupuncture Treatments

The most valuable treatment of TCM for strokes is the combination of body and scalp acupuncture. The cause of a stroke is the occluded blood supply to the brain, but the focus of current rehab medicine is mainly on the upper and lower extremities—hundreds of hours are spent on rehabilitation for these upper and lower extremities. Most physical and occupational therapies are designed for both sets of extremities, but there is no exercise or treatment designed for the brain. With acupuncture, however, not only are these extremities treated, but the cause of the stroke is treated as well with the use of body and scalp acupuncture. It is important to change the medical concepts about stroke rehabilitation because the problem is the brain and doctors not only need to work on the body, but also on the brain.

Acupuncture Treatments for TIAs—Transient Ischemic Attacks

In TIAs, there is dizziness, weakness on one side of the body, with numbness and a tingling sensation, and the symptoms gradually disappear within twenty-four hours. The following points are used with TIAs.

  • Body points: Du 23 Shang Xin, Du 20 Bai Hui, Ex-HN 3 Ying Tang, LI 15 Jian Yu, LI 11 Qu Qi, St 36 Zu San Li, and GB 34 Yang Ling Quan.
  • Scalp points: Motor and Sensory area. (Figure 26.3)

Figure 3-6

 

 

Figure 3-7

 

 

Table 3-1

Points Meridian Number Conditions Helped
1 Shang Xin Du 23 Headaches, eye pain, running nose, mental disorders
2 Bai Hui Du 20 Headache, vertigo, tinnitus, nasal obstruction, aphasia by apoplexy, coma, mental disorders, prolapse of the rectum and uterus.
3 Ying Tang Ex-HN 3 See Table 22.1
4 Jian Yu LI 15 Shoulder and arm pain, motor impairment of the upper extremities, rubella, skin disease
5 Qu Qi LI 11 See Table 12.2
6 Zu San Li St 36 See Table 13.
7 Yang Ling Quan GB 34 See Table 15.3

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.

 

Acupuncture Treatments for Ischemic Strokes

Symptoms of ischemic strokes are facial paralysis, sluggish language, and paralysis on one side of the body. The following points are used with ischemic strokes.

  • Body points: PC 6 Nei Guan, Du 26 Ren Zhong, Sp 6 San Yin Jiao, Ht 1 Ji quan, Lu 5 Qi Zhe, UB 40 Wei Zhong, LI 4 He Gu, and LI 11 Qu Qi.
  • Scalp points: Motor and Sensory area, especially, M1, M2 , S3, Lan 1, Lan 2, and Lan 3.

Table 3.2

Points Meridian Number Conditions Helped
1 Nei Guan PC 6 See Table 16.1
2 Ren Zhong Du 26 Mental disorders, seizure, hysteria, infantile convulsion, coma, apoplexy, off-center deviation of the mouth and eyes, puffiness of the face, low back pain, and stiffness
3 San Ying Jiao Sp 6 See Table 16.1
4 Ji Quan Heart 1 Pain in the rib and cardiac regions, scrofula (skin disease), cold pain of elbow and arm, dry throat
5 Qi Zhe Lu 5 See Table 13.2
6 Wei Zhong UB 40 Low back pain, motor impairment of the hip joint, muscular atrophy, pain, numbness, and motor impairment of the legs, abdominal pain, vomiting, diarrhea
7 He Gu LI 4 See Table 12.1
8 Qu Qi LI 11 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 3-8

 

 

 

Figure 3-9

 

 

Acupuncture Treatments for Facial Paralysis of the Central Type

In this type, the facial paralysis is secondary to a brain stroke. The person’s eye is unable to close, the tongue extends to the stroke side, and there is difficulty opening or closing the mouth, which may be drooping. The following points are used with this type of facial paralysis.

  • Body Points: GB 20 Feng Chi, Ex-HN 5 Tai Yang, St 7 Xia Guan, St 4 Di Chang penetrate to St 6 Jia Che, and LI 4 He Gu for the healthy side.
  • Scalp points: Lan 1, S3.

Table 3-3

Points Meridian Number Conditions Helped
1 Feng Chi GB 20 See Table 22.1
2 Tai Yang EX-HN 5 Headaches, eye diseases, off-center deviation of the eyes and mouth
3 Jia Guan St 7 Deafness, tinnitus, toothache, facial paralysis, face pain, jaw impairment
4 Di Chang St 4 Off-center deviation of the mouth, salivation, twitching eyelids
5 Jia Che St 6 Facial paralysis, toothache, swelling of the cheek and face, mumps, spasms of jaw muscles
6 He Gu LI 4 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 3-10

 

Acupuncture Treatments for Language Deficit

When there is a language deficit, the person can understand instructions, but cannot answer questions; or the person can speak, but cannot understand instructions; or the person can neither understand instructions nor speak correctly. The following points are used with language deficits.

  • Body points: D 23 Shang Xin penetrate to D 20 Bai Hui, GB 20 Feng Chi, Ex-HN 3 Ying Tang, Ex-HN 12 Jin Jin, Ex-HN 13 Yu Ye, Ht 5 Tong Li, UB 10 Tian Zhu, and Ren 23 Lian Quan.
  • Scalp points: Lan 1, Lan 2, and Lan 3.

Table 3-4

Points Meridian Number Conditions Helped
1 Shang Xin Du 23 See Table 29.2
2 Bai Hui Du 20 See Table 16.2
3 Feng Chi GB 20 See Table 22.1
4 Ying Tang Ex-HN 3 See Table 22.2
5 Jin Jin/Yu Ye Ex-HN 12/13 Swelling of the tongue, vomiting, aphasia with stiffness of tongue
6 Tong Li Ht 5 Palpitations, dizziness, blurred vision, sore throat, sudden loss of voice, aphasia with stiffness of the tongue, pain in wrist and elbow
7 Tian Zhu UB 10 Headaches, nasal obstruction, sore throat, neck rigidity, pain in the shoulder and back
8 Lian Quan Ren 23 Swelling and pain of subglossal region (below the tongue), salivation with speech difficulty, non-speech with stiffness of tongue, hoarse voice, difficulty swallowing


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 3-11

 

 

 

Figure 3-12

 

 

Acupuncture Treatments for Upper Arm Paralysis

Symptoms of this type of stroke are weakness and an inability to extend the elbow, wrist, and fingers. The following points are used with upper arm paralysis.

  • Body points: GB 20 Feng Chi, Ht 1 Ji Quan, Lu 5 Qi Zhe, LI 4 He Gu, LI 15 Jian Yu, LI 11 Qu Qi, and SJ 5 Wai Guan.
  • Scalp points: M 2 and M 3.

Table 3-5

Points Meridian Number Conditions Helped
1 Feng Chi GB 20 See Table 22.1
2 Ji Quan Ht 1 See Table 26.2
3 Qi Zhe Lu 5 See Table 13.2
4 He Gu LI 4 See Table 12.1
5 Jian Yu LI 15 Shoulder and arm pain, motor impairment of the upper extremities, German measles, skin disease
6 Qu Qi LI 11 See Table 12.2
7 Wai Guan SJ 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.

 

Acupuncture Treatments for Shoulder Pain and Frozen Shoulder

Symptoms include difficulty raising shoulder, limited range of motion, difficulty combing hair, putting on a bra, and inserting the arm into a sleeve. The following points are used for shoulder pain and frozen shoulder.

  • Body points: LI 15 Jian Yu, Du 26 Ren Zhong, SI 9 Jian Zhen, SI 15 Jian Zhong Shu, SI 14 Jian Wai Shu, and St 38 Tiao Kou.
  • Scalp points: M 2 and M 3.

Table 3-6

Points Meridian Number Conditions Helped
1 Jian Yu LI 15 See Table 26.5
2 Ren Zhong Du 26 See Table 29.2
3 Jian Zhen SI 9 Pain in the shoulder area, impairment of hands and arms
4 Jian Zhong Shu SI 15 Cough, asthma, pain in the shoulder and back
5 Jian Wai Shu SI 14 Aching shoulder and back, neck pain and rigidity
6 Tiao Kou St 38 Numbness, soreness and pain of the knee and leg, weakness and impairment of the foot, pain and impairment of the shoulder, abdominal pain

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.

Acupuncture Treatments for Lower Extremity Paralysis

Symptoms include weakness, difficulty lifting leg, and walking. The following points are used for lower extremity paralysis.

  • Body points: UB 40 Wei Zhong, Sp 6 San Ying Jiao, GB 30 Huan Tiao, GB 34 Yang Ling Quan, and UB 60 Kun Lun.
  • Scalp points: M 1 and M 2.

Table 3-7

Points Meridian Number Conditions Helped
1 Wei Zhong UB 40 Low back pain, motor impairment of the hip joint, hemiplegia (paralysis), pain, numbness, and motor impairment of the lower extremities, abdominal pain, vomiting
2 San Ying Jiao Sp 6 See Table 16.1
3 Huan Tiao GB 30 Pain of the lumbar region and thigh, muscular atrophy of the lower limbs
4 Yang Ling Quan GB 34 See Table 15.3
5 Kun Lun UB 60 Headaches, blurred vision, neck rigidity, nosebleed, shoulder, back, and arm pain, swelling and pain of the heel, difficult labor, epilepsy

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.

 

Acupuncture Treatments for Poor Balance and Unsteady Gait

The following points are used for poor balance and an unsteady gait.

  • Body points: GB 19 Nao Kong penetrating to GB 20 Feng Chi, UB 9 Yu Zhen penetrating to UB 10 Tian Zhu, Du 17 Nao Hu penetrating to Du 16 Feng Fu, and GB 20 Feng Chi.
  • Scalp points: Balance area.

Table 3-8

Points Meridian Number Conditions Helped
1 Nao Kong GB 19 Headaches, stiffness of the neck, vertigo, painful eyes, tinnitus, epilepsy
2 Feng Chi GB20 See Table 22.1
3 Yu Zhen UB 9 Headaches and neck pain, dizziness, pain in the eye, nasal obstruction
4 Tian Zhu UB 10 Headaches, nasal obstruction, sore throat, neck rigidity, pain in the shoulder and back
5 Nao Hu Du 17 Epilepsy, dizziness, pain and stiffness of the neck
6 Feng Fu Du 16 Headaches, neck rigidity, blurred vision, nosebleed, sore throat, 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 3-13

 

 

 

Figure 3-14

 

 

 

Acupuncture Treatments for Blindness

The following points are used for blindness.

  • Body points: GB 20 Feng Chi and UB 10 Tian Zhu.
  • Scalp points: Vision area.

Table 3-9

Points Meridian Number Conditions Helped
1 Nao Kong GB 19 Headaches, stiffness of the neck, vertigo, painful eyes, tinnitus, epilepsy
2 Feng Chi GB20 See Table 22.1
3 Yu Zhen UB 9 Headaches and neck pain, dizziness, pain in the eye, nasal obstruction
4 Tian Zhu UB 10 Headaches, nasal obstruction, sore throat, neck rigidity, pain in the shoulder and back
5 Nao Hu Du 17 Epilepsy, dizziness, pain and stiffness of the neck
6 Feng Fu Du 16 Headaches, neck rigidity, blurred vision, nosebleed, sore throat, 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.

 

Acupuncture Treatments for Difficulty Swallowing

The following points are used for difficulty in swallowing.

  • Body points: PC 6 Nei Guan, Du 26 Ren Zhong, GB 20 Feng Chi, and Ren 23 Lian Quan.
  • Scalp points: M 2 and M 3.

Figure 3-15

 

Table 3-10

Points Meridian Number Conditions Helped
1 Nei Guang PC 6 See Table 16.1
2 Ren Zhong Du 26 See Table 29.2
3 Feng Chi GB 20 See Table 22.1
4 Lian Quan Ren 23 Swelling and pain of subglossal region (below the tongue), salivation with speech difficulty, non-speech with stiffness of tongue, hoarse voice, difficulty swallowing

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.

 

Acupuncture Treatments for Constipation

The following points are used for constipation.

  • Body points: St 40 Feng Long, St 28 Shui Dao,and  St 29 Gui Lai.
  • Scalp points: M 2 and M 3.

Table 3-11

Points Meridian Number Conditions Helped
1 Feng Long St 40 Headaches, dizziness, cough, asthma, excessive sputum, chest pain, constipation, epilepsy, muscular atrophy, motor impairment, pain, swelling, or paralysis of lower extremities
2 Shui Dao St 28 Retention of urine, swelling, hernia, painful menstruation
3 Gui Lai St 29 Abdominal pain, hernia, painful, irregular menstruation, absence of menstruation, white vaginal discharge, collapsed uterus

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 3-16

 

Acupuncture Treatments for Stoppage of Urine Flow

The following points are used for stoppage of urine flow.

  • Body points: UB 54 Zhi Bian penetrate to St 28 Shui Dao, and Ren 3 Zhong Ji.
  • Scalp points: M 2 and M 3.

Table 3-12

Points Meridian Number Conditions Helped
1 Zhi Bian UB 54 Low back pain, muscular atrophy, motor impairment of the lower extremities, painful urination, swelling around external genitalia, hemorrhoids, constipation
2 Shui Dao St 28 Hernia, swelling, painful menstruationurine retention
3 Zhong Ji Ren 3 Bedwetting, nocturnal emissions, impotence, hernia, uterine bleeding, irregular menstruation, frequency of urination, retention of urine, pain collapse of uterus, in the lower abdomen, vaginitis

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.

Acupuncture Treatments for Urinary Incontinence

The following points are used for urinary incontinence.

  • Body points: Ren 4 Guan Yuan, Ren 6 Qi Hai, and Ki 3 Tai Xi.
  • Scalp points: M 2 and M 3

Table 3-13

Points Meridian Number Conditions Helped
1 Guan Yuan Ren 4See Figure 3-15 Bedwetting, frequency of urination, retention of urine, hernia, irregular menstruation, uterine bleeding, postpartum hemorrhage, lower abdominal pain, indigestion, diarrhea, collapse of rectum
2 Qi Hai Ren 6See Figure 3-15 Abdominal pain, bedwetting, impotence, hernia, swelling, diarrhea, dysentery, uterine bleeding, irregular menstruation, white vaginal discharge, postpartum hemorrhage, constipation, asthma
3 Tai Xi Ki 3 See Table 14.4

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.

 

William’s Treatment

William underwent my treatment for two months, after which his muscle strength gradually improved to the point that he could move his shoulders, elbows, hips, and knees. By constantly flexing these joints, he had no problem with flexion and extension movements in them, but he still needed treatment for muscle strength and range of motion in the wrists and ankles. For these, he came in two to three times a week for eight weeks, then only once a week for ten weeks, at which time he was also given physical therapy to help muscle strength and range of motion for the upper and lower extremities. All these treatments helped William immensely.

Stroke treatment by acupuncture focuses on the brain and blood supply. Since the main cause of a stroke is a decreased supply of blood to the brain in either ischemic or hemorrhagic strokes, replenishing the brain’s blood supply greatly improves the functions of the paralyzed parts of the body. It is necessary to treat not only the upper and lower extremities, but also the brain, or the person will be at a functional disadvantage. Thus the combination of treatments works best for anyone who has had a stroke.

A combination of acupuncture, therapy, and therapeutic massage, done together, is the best hope for totally recovering from a stroke.

 

Tips For People Who Have Had a Stroke

  • You should ask your acupuncturist to perform the acupuncture treatments for both the body and the scalp.
  • The earlier you seek out acupuncture treatment, the better your chances for recovery.
  • Always try to fight the effects of the stroke by not using your unaffected extremity, but instead forcing yourself to use the paralyzed part.
  • The combination of acupuncture, physical therapy, therapeutic massage, and self-motivated exercise is the best approach for recovery.

 

 

38. Acupuncture and Shoulder Arthritis

Feb 21, 2012   //   by drxuacupuncture   //   Blog, Case Discussions, Uncategorized  //  No Comments

News Letter, Vol. 4 (2), Februrary  , 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

 

Shoulder Arthritis

www.drdavidduckworth.com.au

 

Brittany, a sixty-five-year-old woman, experienced on-and-off pain in her shoulder for two or three years, especially upon awakening. The pain was located on the front, sometimes the top, of her shoulder, which made everyday tasks, such as reaching for a high shelf or combing her hair, difficult for her. It also caused swelling of her right shoulder, which became worse when the weather changed, so much so that she told her friends she was a human weathervane. Recently, she began to feel a clicking or grinding sound in the shoulder, and it became increasingly difficult to fall or stay asleep due the pain, which has been increasing for several years.

Brittany was a basketball player in college and sometimes when she shot the ball she felt some pain, but it went away after a day or two. She began taking Tylenol and Advil, which gave some relief, but because she was so occupied with her own business, and because she always assumed the pain would eventually go away, she never made the time to go to a doctor before she came to me.

In my physical exam, I found the deltoid muscle of her right shoulder was atrophied. The right shoulder front, top, and back of the shoulder blade were all tender. When I performed a range of motion test, the flexing in the right shoulder was about 0–120 degrees and her extension was about 0–115 degrees, with pain in the 0–70 degree extension. The grinding, cracking noise that accompanied this extension made the pain in this shoulder feel worse, but I found no signs of arthritis in other joints, including the left shoulder, which was perfectly normal.

 

Symptoms, Causes, and Diagnosis

There are two main shoulder joints

The glenohumeral joint, which is also called the bone-circuit joint. Here, the typical pain is on the top and back of the shoulder and it sometimes involves pain in the shoulder blade, the scapula, and restricted range of motion.

The acromioclavicular joint. Arthritis can develop where the collarbone meets the shoulder blade (scapula), at the bony prominence on the top of the shoulder blade known as the acromion. The pain is at the top of the shoulder and increases when, for example, the arm is crossed in front of the body to touch the other shoulder, or the arm is raised to comb the hair or take something from a high shelf.

Figure 2.1

 

There are three principal types of arthritis.

Osteoarthritis, inflammation of the joints, is caused by wear and tear.

Rheumatoid arthritis, an autoimmune disease that is usually a symmetrical inflammation of the joints, especially the shoulder, knee, and other small joints.

Posttraumatic arthritis, which results from injury.

 

Treatments for Shoulder Arthritis in Western Medicine

Noninvasive Treatments

The first methods to try are the nonsurgical treatments.

Rest

Rest and changing physical activities. The person should avoid any activity that provokes pain.

Compresses

Using hot and cold compresses can be very helpful.

Physical Therapy

Physical therapy and massages. Below are a few exercises that will help strengthen the rotator cuff to allow more fluid motion. Three sets of 10 each should be performed 3 times a week.

 

Figure 2.2

 

 

Figure 2.3

 

 

Surgery

If non-surgical treatments do not work, then surgery would be necessary.

Resection arthroplasty is the most common surgical procedure for arthritis of the acromioclavicular joint. Its purpose is to restore the flexible connection between the acromion and the collarbone. A small piece of bone from the end of the collarbone is removed, leaving a space that later fills in with scar tissue.

Total shoulder arthroplasty for glenohumeral joint arthritis. In this procedure, a surgeon replaces the entire shoulder joint with a prothesis.

Hemiarthroplasty, also for glenohumeral joint arthritis. In this procedure, the surgeon replaces the head of the upper arm bone. One joint surface is replaced with an artificial material, usually metal.

I suggest to most of my patients that they try the nonsurgical treatments first. However, if the pain is intolerable and severely restricts sleep, a surgical treatment might be the better of the two options.

 

Treatments for Shoulder Arthritis in Traditional Chinese Medicine

Acupuncture

When performed appropriately, acupuncture can help with these two types of osteoarthritis.

For glenohumeral osteoarthritis, I use Jian Yu, Jian Liao, Jian Zhen, Quchi He Gu, and also Tian Zhong and Jian Qian. All needles need to be inserted to about 1.5 inches with electrical stimulation for about 30 minutes. The patient must be in a seated position and the electrical stimulation should be as high as can be tolerated.

For acromioclavicular osteoarthritis, it is essential to locate the exact point of tenderness in the front of the shoulder and the AC joint and insert the needle into that AC joint, then the remaining points as in the preceding paragraph. This principle of treatment is called “acupuncture points selection based on the pain location,” aka the specific anatomical location following the pain points.

Table 2.1

Points Meridian/No. Location
1 Jian Qian Extrapoints 23 See Fig 2.4
2 Jian Yu LI 15 See Fig 2.4
3 Jian Zhen SI 9 See Fig 2.4
4 Jian Liao SJ 14 See Fig 2.5
5 Tian Zhong SI 11  See Fig 2.5
5 Qu Chi LI 11 See Fig 2.4
7 Wai Guan SJ 5 See Fig 2.4
8 He Gu LI 4 See Fig 2.4

 

 

 

 

 

Fig 2.4

 

 

 

 

 

 

 

 

 

 

Fig 2.5

 

 

 

 

 

 

 

 

 

 

 

Brittany’s Treatment

Brittany had an X-ray which showed that the cartilage of her right shoulder was wearing out. On the glenohumeral joint there was a loss of joint space and bone spurs were present. She was also given a blood test to rule out rheumatoid arthritis, and it came back negative.

Brittany was advised to avoid lifting anything heavy, to stop using weights, or doing any other upper-extremity exercises, including basketball, if she still played that sport.

If her shoulder was swollen, Brittany was advised to use a cold pad for 15–20 minutes 3 times a day; conversely, if there was no swelling, then she was advised to use a heating pad in the same manner. Acupuncture, physical therapy, and massage were to be tried before any surgery was performed.

Brittany received treatment 3 times a week for 6–8 weeks and her shoulder pain was much relieved. However, I had to advise her that acupuncture cannot change the lost cartilage or remove the clicking, snapping sound. It could decrease the pain, making it improved enough that she would be able to get a good night’s sleep and could prolong the need for surgery. Brittany reported that this was indeed the case after the treatments. For now, her pain has sufficiently diminshed to allow her to go on living her life without having to resort to surgery. [Ed.Supplied an upbeat update that was needed here.].

 

Tips for People with Shoulder Osteoarthritis

  • If your shoulder is a normal temperature, always put a heating pad on it twice a day for 30 minutes each time. If it is hot, place a cold pad there for the same amount of time.
  • After the hot or cold pad, spend 30 minutes a day doing range-of-motion exercises for the shoulder. These will greatly improve your shoulder mobility and decrease the pain.

 

 

33. Acupuncture and Lateral Ankle Sprain

Sep 20, 2011   //   by drxuacupuncture   //   Blog, Case Discussions, Uncategorized  //  1 Comment

 

News Letter, Vol. 3 (9), September, 2011, © 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

 

Lateral Ankle Sprain

Fig 9.1

Douglas is a 26 year-old male football player who has been experiencing right lateral ankle pain after a month of strenuous exercise.  He was training for the 100-meter dash when he felt a pain in his right ankle that caused him to fall.  He was immediately taken to a sports medicine doctor who found his right ankle to be moderately swollen, though because of the severe pain Douglas felt, the doctor immediately sent him for an MRI without contrast of the right ankle.  The MRI showed no fracture, no ankle bone dislocation, though showed there was a ligament sprain of the right ankle.

 

The patient was given preventative treatment known as RICE, which stands for:  R is rest; the patient was ordered to stay off the right ankle.  I is ice for ice packs to be held to the affected area to decrease both the inflammation and the swelling.  C is for compression: the patient was given an elastic sock to wear on his right ankle and E is elevation, so the patient was instructed to elevate his leg to decrease the edema and the swelling.

 

The patient gradually felt better, however he still felt pain in the right lateral ankle after a month, so he came to me for further treatment and evaluation.

 

I noted the ankle was still slightly swollen and the lateral right side of it was very tender.  The range of motion of the right ankle dorsiflexion, i.e. his right foot bend up to his nose was 0-30 degrees and the plantarflexion, i.e. his foot bend down to the ground, 0-20 degrees, though with pain.

 

The patient had suffered a lateral ankle sprain, the most common form of ankle sprains, which accounts for 80% of this type injury.  There are three small ligaments in the ankle which are very easy to sprain.

  1. Anterior talofibular ligament (ATFL):  This is the most common ligament injury
  2. Calcaneofibular ligament (CLF): This is the second most common and
  3. Posterior talofibular ligament (PTFL):  This is the last to be injured.

http://www.webmd.com/hw-popup/ankle-sprain Fig 9.2

All of these three ligaments function to stabilize the ankle during inversion, so when the ankle experiences inversion on the plantarflexed foot, this is the most vulnerable position.

 

http://www.midwestsportsfans.com Fig 9.3

Ankle Sprain Causes

The ankle pain is most often caused by injury to the ligaments, not bone. Ankle ligaments, especially as mentioned above are injured most commonly when the foot is turned inward or inverted by a force greater than the ankle ligaments can sustain. This kind of injury can happen in the following ways:

  • Sports: such as football, basketball, tennis, when the athlete landed with the plantar foot inverted and the downward force. A common example is a basketball player who goes up for a rebound and comes down on top of another player’s foot. This can cause the rebounder’s foot to roll inward.)
  • Fall while stepping on an irregular surface, such as stepping in a hole.
  • The most common ankle sprains are Inversion injuries, in which the foot rolls inward, are more common than eversion injuries (also referred to as a high ankle sprain), in which the foot twists outward.

There are three grades of lateral ankle sprains:

  1. Grade 1 is mild, which includes partial tear of the ATFL and intact CFL and PTFL.  There is no instability, mild swelling and point tenderness at the lateral aspect of the ankle.
  2. Grade 2 is moderate.  There is a complete tear of the ATLF and partial tear of the CLF.  The patient’s ankle is very unsteady and exhibits diffuse swelling and ecchymosis.
  3. Grade 3, severe. This is the complete tear of the ATFL and CFL.  The patient in this case is extremely unsteady.

 

Western medicine treatment.

  1. During the acute stage the ankle is treated with RICE, as detailed above.
  2. Nonsurgical treatment only can treat grade 1 and possibly part of grade 2; grade 3 requires surgery.
  3. Physical Therapy:

 

A rocker boot helps to promote a more natural gait while providing stability for severe ankle sprains, fractures of the foot and for post-operative use.  There are many types of rocker boots, but most feature adjustable air cells to ensure a custom snug fit to accommodate any foot.

 

Ensuring optimal pain free motion is needed to help with recovery.  Starting with Active Range of Motion perform up to 30 pain free reps of the 4-Way Ankle Movements before moving on to resistance with strengthening.  Strengthening the muscles of the ankle and lower leg is important to prevent imbalances and future weakness in the ankle.

 

1: Dorsiflexion – foot is pulled back towards the body against resistance

2: Plantarflexion – foot is pushed down away from the body against resistance

3: Inversion – foot is turned down and in against the resistance

4: Eversion – foot is turned up and out against the resistance

Fig 9.4

 

 

Fig 9.5

 

 

 

Fig 9.6

 

 

Fig 9.7

 

 

 

To continue to strengthen the stabilizing muscles of the ankle and improve proprioception work on standing balance on the ground.  After, continue to progress to balance with a foam pad for 2 sets of 30 seconds.

Fig 9.8

 

 

 

This will assist in strengthening the stabilizing muscles of the ankle and help to regain balance in circumstances where the ankle may be injured again such as in basketball when going up for rebound and coming down on another players ankle.  The wobble board once balance is achieved in standing on a flat surface and on the foam pad can be used again, this time in a standing position.

 

Traditional Chinese medicine treatment:

 

Many patients tried everything before they came to me. They usually had different treatments for years. However, they still feel pain with difficulty standing, and walking. They have extreme pain by walking a long distance, such as during vacation. Acupuncture might be their last resort.

 

My personal experience is that we first have to make a clear diagnosis by palpating the tender points to differentiate injuries of the three ligaments: the most common injured ligament is ATFL, the second most common injured ligaments are ATFL and CFL. You will see rarely the PTFL injury. After palpation, you can clearly understand the source of the problems. Then you can treat the injury accordingly.

 

The following acupuncture points are usually selected: Sp 6 San Ying Jiao, UB 62 Sheng Mai, GB 40 Qiu Xu, UB 60 Kun Lun,  PC 6 Nei Guan, and St 36 Zu San Li.

Sp 6 is the crossing points for three Ying Meridians, therefore, it can adjust all three meridians energy, and smooth the blood and qi. UB62 is located at the ATFL, therefore, it is very important to use for the ATFL injury. GB41 coincident at CFL, it will help UB62, both UB 62 and GB 41 will bring blood flow to the injured ATFL and CFL ligaments to facilitate healing. PC 6 and St 36 helps adjust the entire energy flow in the body.

Points Meridian/No. Location Function/Indication
1 San Yin Jiao Sp 6 3 inches directly above the tip of the medial malleolus, on the posterior border of the medial aspect of the tibiaFigure 24.22 Abdominal pain, distension, diarrhea, dysmenorrheal, irregular menstruation, uterine bleeding, morbid leucorrhea, prolapse of the  uterus, sterility, delayed labor, night bed wet, impotence, enuresis, dysuria, edema, hernia, pain in the external genitalia, muscular atrophy, motor impairment, paralysis and leg pain, headache, dizziness and vertigo, insomnia
2 Shen Mai UB 62 In the depression directly below the external malleolus Epilepsy, mania, headache, dizziness, insomnia, backache, aching of the leg
3 Qiu Xu GB 40 Anterior and inferior to the external malleolus, in the depression on the lateral side of the tendon of extensor digitorum longus Pain in the neck, swelling in the axillary region, pain in the hypochondriac region, vomiting, acid regurgitation, muscular atrophy of the lower limbs, pain and swelling of the external malleolus, malaria.
4 Kun Lun UB 60 In the depression between the external malleolus and archillus tendon Headache, blurring of vision, neck rigidity, epistaxis, pain in the shoulder, back and arm, swelling and heel pain, difficult labor, epilepsy
5 Nei Guan PC 6 2 inch above the transverse crease of the wrist, between the tendons of m. palmaris longus and m. flexor radialis. Cardiac pain, palpitation, stuffy chest, pain in the hypochondriac region, stomachache, nausea, vomiting, hiccup, mental disorders, epilepsy, insomnia, febrile diseases, irritability, malaria, contracture and pain of the elbow and arm.
6 Zu San Li St 36 3 inch below St. 35 Du Bi, one finger below the anterior crest of the tibia, in the muscle of tibialis anterior Gastric pain, vomiting hiccup, abdominal distension, borborygmus, diarrhea, dysentery, constipation, mastitis, enteritis, aching of the knee joint and leg, beriberi, edema, cough, asthma, emaciation due to general deficiency, indigestion, apoplexy, hemiplegia, dizziness, insomnia,

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Fig 9.9

 

 

 

 

Treatment course for Douglas:

Douglas underwent my treatment 2-3 x per week for about 5 weeks, besides acupuncture treatment, he also was guided to have strengthening exercise for his right ankle.  I realized that acupuncture treatment only might take a longer time to recover, however, if we combine acupuncture with physical therapy and ankle brace, the patient will have much less pain and resume their regular walk sooner. After 5 weeks treatment, Douglas started his regular walk with mild tenderness; he can sustain much longer ambulation without pain.

 

Tips for Acupuncturist:

 

    1. Acupuncture and physical therapy can treat only the grade 1 ankle sprain.  If grade 2 or 3 is concerned, you should encourage the patient to consult an orthopedic physician.
    2. Acupuncture is a good treatment for long-term ankle pain, you may need to treat the patient for a few months in order to get better results.
    3. You should encourage your patients to use ankle brace to protect ankle joint.
    4. Electrical stimulation with UB 60, UB 62 and GB40 for 30 min are very important.

 

Tips for Patients:

 

  1. For grade 3 sprain, you may consider surgery for reparation. However, if you have grade 1 or 2, be very cautious to have surgery. I have patients who went through many surgeries, have had long term pain for many years.
  2. You should always massage the three points, UB 60, UB 62 and GB40 5-10 min in the morning and evening everyday. If you have anti-inflammatory cream for massage, you will get better results.

30. Dr. Xu’s Book Signing, Acupuncture and Burning sensation at right lateral thigh

Jun 12, 2011   //   by drxuacupuncture   //   Blog, Case Discussions, Uncategorized  //  1 Comment

 

Dear Friends:

You are cordially invited by Jun Xu, M.D. to talk and signing of his new book: “Magic Needles, Feel Younger and Live Longer with Acupuncture”

at Auditorium of Christ Church, 254 East Putnam Avenue, Greenwich, CT on Sunday, June 26, 2011 at 10:30 AM. Dr. Xu will also present lecture of ” Neck Pain after Computer Use, Allergy and Sinusitis, How May Acupuncture and Chinese Herbs Help You?” Please join this exciting event.

Jun Xu, M.D. and Staff

News Letter, Vol. 3 (6), June, 2011, © 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 begin_of_the_skype_highlighting (203) 637-7720 end_of_the_skype_highlighting

 

 

 

Burning sensation at right lateral thigh

 

Fig 6.1

Janina S., a 54-year-old female, has been experiencing a tingling sensation and numbness on the outside of her right thigh for six months.  The pain sometimes burned, sometimes was dull and extended to the groin area and the buttock.  It often became worse when Janina did much walking or standing and she felt altered sensation in the front and lateral of thigh.  Sometimes she woke up in the night feeling pain on the lateral front of the thigh.  She consulted her primary care physician who told her she probably had a pinched nerve on her lower back and was given physical therapy, which did not help her at all.  She had an X-ray and an MRI which showed negative findings, so she was frustrated at not getting to the cause of her problem or given any treatment for it.

She was then referred to me for examination and treatment.  I found no tenderness on the lower back or lateral side of the thigh, and no decreased range of motion of the lower back, hip or knee, except that there was slightly  decreased sensation of the anterior and lateral thigh.  I concurred with her regular physician that she probably had a pinched nerve, but need further explanation to the patient.

This nerve is called the lateral femoral cutaneous nerve, which passes underneath the inguinal ligament and might be compressed, thus causing the numbness, tingling and burning sensation in the lateral and anterior thigh.  In most people this nerve passes through the groin to the upper thigh without any compression, but there is a condition, named as meralgia paresthetica, i.e. the lateral femoral cutaneous nerve is trapped and becomes pinched under inguinal ligament.

Fig. 6.2 Anatomy of the lateral femoral cutaneous nerve.

http://emedicine.medscape.com/article/1141848-overview

Fig. 6.3 Sensory distribution of the lateral femoral cutaneous nerve.

Common causes of this compression include the following:

  1. Tight clothing.
  2. Obesity
  3. Pregnancy
  4. Scar tissue around the inguinal ligament
  5. Walking, cycling or standing for long periods of time.
  6. Other conditions such as diabetes, alcoholism and thyroid disorder.

The diagnosis of meralgia paresthetica is based mainly on physical examination and patients’ complaints, especially as laboratory studies such as blood tests and imaging studies – MRI’s, X-rays – are not very specific, though an EMG and nerve conduction studies may be helpful in making a diagnosis.

History

  • When the LFCN is entrapped, patients usually feel pins, needles, numbness, tingling, sometimes burning, sharp pain sensation at the lateral thigh. Because individual LFCN distribution might be different, some patients may have the above symptoms, i.e.paresthesias at frontal and/or back of the thigh, or groin area.
  • Symptoms are typically unilateral.  However, they may be bilateral in up to 20% of cases.
  • Biking, Swimming, walking, standing, running  may aggravate the symptoms; sitting tends to relieve them.

Physical Examination:

  • Numbness, tingling sensation, i.e. paresthesias, can be revealed  at frontal and lateral thigh.
  • Occasionally, patients are very sensitive to touch, and feels burning, and sharp pain with palpation, i.s. hyperesthetic in this area.
  • Tapping over the upper and lateral aspects of the inguinal ligament or slightly over extending the thigh backward, which stretches the nerve, may reproduce or worsen the paresthesias.
  • Pelvic compression testing is positive. By deep palpation just below the anterior superior iliac spine at the groin area may reproduce the symptom.
  • Motor strength in the involved leg most likely is normal.

Treatment with western medicine:

  1. Lifestyle and home remedies such as avoidance of tight clothes, weight loss, maintaining a steady low weight and avoiding standing or walking for long periods can be helpful.
  2. Medications.  There are many helpful medications for this condition, including corticosteroid injections which can reduce inflammation and temporary relief of pain, also tricyclic antidepressants and Neurotin.
  3. Physical therapy
  4. When the pain is severe, a focal nerve block can be done at the inguinal ligament with a combination of lidocaine and corticosteroids. This should temporarily relieve the symptoms for several days to weeks. Ultrasound guidance for the blockade may be beneficial in patients with regional anatomical variations.

Traditional Chinese medicine:

  1. Acupuncture body acupuncture:

The acupuncture points usually I choose are: Sp 12 Chong Men, Sp 13 Fu She, GB 29 Ju Liao, GB 31 Feng Shi, GB 32 Zhong Du, Arshi, GB 34 Yang Ling Quan, Sp 10 Xue Hai and Liv 3 Tai Chong.

These insertions are combined with electrical stimulation for 30 minutes three times a week for about four weeks.

Points Meridan/No. Location Function/Indication
1. Chong Men Sp 12 Superior to the lateral end of inguinal groove, on the lateral side of the femoral artery, at the level of the upper border of symphysis pubis Abdominal pain, hernia, dysuria, local groin pain
2. Fu She Sp 13 0.7 inch laterosuperir to Chong Men, 4 inch laeral to the midline of the body Lower abdominal pain, hernia, local groin pain
3. Ju Liao GB 29 In the depression of the midpoint between the anterosuperior iliac spine and the great trochanter Pain and numbness in the thigh and lumbar region, paralysis, muscular atrophy of the lower limbs
4. Feng Shi GB 31 On the midline of the lateral aspect of the thigh, 7 inch above the transverse politeal crease. When the patient is standing erect with the hands clse to the sides, the point is where the tip of the middle finger touches Pian and soreness in the thigh and lumbar region, paralysis of the lower limbs, beriberi, gereral prutitus
5. Zhong Du GB 32 On the lateral aspect of the thigh, 5 inches above the transverse popiliteal crease, between vastus lateralis and biceps femoris muscles Pain and soreness of the thigh and knee, numbness and weakness of the lower limbs, hemiplegia
6. Yang Ling Quan GB 34 In the depression anterior and inferior to the head of the fibula Hemiplegia, weakness, numbness and pain of the knee, beriberi, hypochondriac pain, bitter taste in the mouth, vomiting, jaundice, infantile, convulsion
7. Xue Hai Sp 10 When the knee is flexed, 2 inch above the medial edge of patella. Irregular menstruation, dysmenorrheal, uterine bleeding, amenorrhea, urticaria, eczema, erysipelas, pain in the medial aspect of the thigh
8. Tai Chong Liv 3 On the dorsum of the foot, in the depression distal to the junction of the first and second metatarsal bones. Headache, dizziness and vertigo, insomnia, congestion, swelling and pain of the eye, depression,, infantile convulsion, deviation of the mouth, pain in the hypochondriac region, uterine bleeding, hernia, enuresis, retention of urine, epilepsy, pain the anterior aspect of the medial malleolus

Fig 6.4

Fig 6.5

  1. Blossom needles should tap the front and lateral of the thigh skin, allowing the lateral femoral cutaneous nerve distribution.

Fig. 6.6

Janina underwent treatment with both acupuncture and blossom needle tapping and was much improved after five visits.

Tips for patients:

  1. You have to talk to an MD physician to find out other possible diagnosis, such as Lumbar Sacral radiculopathy, Sciatica and peripheral polyneuropathy, etc.
  2. Check if you are wearing a tight cloth, sometimes, you only need wear a loose cloth.
  3. If you are overweight, you may have to lose weight.
  4. If you like bike or other repetitive exercise, please pay attention to the inguinal area, you have to rest a while then restart your exercise.

Tips for Acupuncture practitioners:

  1. Make sure you have a clear diagnosis, if the patient has other illness instead of lateral femoral cutenous neuropathy, the above treatment will not work.
  2. You may have to use both body and blossom needles to treat your patients.
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