Browsing articles tagged with " Dr. Xu"

69. Occipital Headache, How Can Acupuncture Treat It?

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

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

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

www.drxuacupuncture.co

Rehabilitation Medicine and Acupuncture Center

1171 East Putnam Avenue, Building 1, 2nd Floor

Greenwich, CT 06878

Tel: (203) 637-7720

How Can Acupuncture treat Occipital Neuralgia?

 

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

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

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

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

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

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

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

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

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

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

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

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

Tips for acupuncturists:

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

Tips for patients:

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

 

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

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

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

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

www.drxuacupuncture.co

Rehabilitation Medicine and Acupuncture Center

1171 East Putnam Avenue, Building 1, 2nd Floor

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

Cervical Dystonia




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

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

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

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

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

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

Tests and diagnosis:

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

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

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

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

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

Medications:

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

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

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

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

4.Carbamazepine is an anticonvulsant.

Botox injections:

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

Other treatments:

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

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

Chinese medicine:

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

  1. Acupuncture

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

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

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

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

  1. Moxibustion:

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

  1. Guasha (Scrape) :

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

Tips for acupuncturists:

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

Tips for patients:

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

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

 

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.

 

 

26. Acupuncture and Carpal Tunnel Syndrome

Feb 17, 2011   //   by drxuacupuncture   //   Blog, Case Discussions, Uncategorized  //  No Comments

News Letter, Vol. 3 (1), February, 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

Carpal Tunnel Syndrome

www.0831120.com

Jessica is a 35 year old computer programmer, who for the last 15 years, works roughly 10 hours a day at the computer.   For last 2 years, she started to feel right hand numbness and tingling sensation along her thumb, index and middle fingers. This sensation often occurs while holding a steering wheel, phone, newspaper or upon awakening. She very often “shakes out” her right hand to try to relieve symptoms, especially when the pain interferes with sleep waking her up. As the disorder progresses, the numb feeling becomes constant. She sometimes also feels right wrist pain radiating up to arm and shoulder, and also down to palm, especially at end of the day after spending a long time typing. She has difficulty holding a book or cup and very often drops her book or other objects. She tried to massage her hand and wrist, however, she felt no improvement. She then came to me for evaluation and treatment.

I performed a physical examination, finding out while I squeezed her right palm together and held for 2 mins, she started to feel numbness and tingling sensation at thumb, index and middle fingers. By comparison, her muscles of  right thumb and lateral palm are slightly atrophy and the sensation is decreased by using pinpoint.  Suspecting this patient had carpel tunnel syndrome, I also performed the following two tests:

1. Tinel’s sign. I used my hammer to tap lightly at the middle line of the wrist above the carpal tunnel, so the patient felt the sensation of tingling or pins and needles following to the first three fingers.

Fig 2.1

www.flickr.com

2. Phalen’s maneuver.  I asked the  patient to flex the wrist about 60-80 degrees, then waited for one minute, which caused her to feel numbness and tingling following along the median nerve distribution.

Fig.2.2

www.flickr.com

Jessica most likely suffered from carpal tunnel syndrome. Carpal tunnel is a tunnel located at the midline of palm adjacent to the wrist, median nerve lies inside the tunnel.  The median nerve is a mixed nerve, meaning it has a sensory function and also provides nerve signals to move your muscles (motor function). The median nerve provides sensation to your thumb, index finger, middle finger and the middle-finger side of the ring finger.

Fig. 2.3

www.thepainsource.com

Pressure on the nerve can stem from anything that reduces the space for it in the carpal tunnel.

There are several causes of carpel tunnel syndrome:

1.      Most are idiopathic (not knowing the cause)

2.      Genetic predisposition.  Many families have this tendency toward carpel tunnel syndrome.  About 50% of those who develop the condition are women, where this complaint runs in the family. It may be that your carpal tunnel is more narrow than average.

3.      Professionally related.  Though there is some controversy over this, certain professions such as data entry technicians, secretaries, construction workers etc. have high liability toward carpel tunnel syndrome.  Repetitive flexing and extending of the tendons in the hands and wrists, particularly when done forcefully and for prolonged periods without rest, can increase pressure within the carpal tunnel. Injury to your wrist can cause swelling that exerts pressure on the median nerve.

4.      Diseases related conditions such as trauma, pregnancy, multiple myeloma, amyloid, rheumatoid arthritis, acromegaly, mucopolysaccharidosis or hypothyroidsm compress the median nerve, and all can cause the symptoms of carpel tunnel syndrome.  If the cause of the disease is treated, then carpel tunnel syndrome will gradually disappear.

How is carpal tunnel syndrome diagnosed?

1.      Most important: Your symptoms.  As mentioned above, if  you have numbness and tingling sensation at thumb, index, middle and half of the ring fingers, if you wake up and shake your hand try to relieve hand pain and numbness, if  you very often drop off the object, such as books, cup, pen, etc., the diagnosis of carpal tunnel syndrome is suspected.

2.       By physical examination:  Sometimes tapping the front of the wrist can reproduce tingling of the hand, and is referred to as Tinel’s sign and Phalen’s sign of carpal tunnel syndrome. Symptoms can also at times be reproduced by the examiner by bending the wrist forward (referred to as Phalen’s maneuver).

3.      Nerve Conduction Velocity test (NCV)and Electromyogram (EMG) :

The golden standard for the diagnosis of carpel tunnel syndrome is electrophysiological testing, i.e. nerve conduction and electromyography.  Usually a physical examination, coupled with the patient’s complaints on her condition, are sufficient to make an accurate diagnosis.  However, the final diagnosis depends on the electrophysiological testing. The test not only will tell you the diagnosis, but also the types of treatment and prognosis, if your condition needs physical therapy, acupuncture, brace, steroid injection, or surgery, etc. if your condition is reversible or non-reversible, etc.

There are two parts of electrophysiological tests, i.e. Nerve Conduction Velocity Study (NCV) and Electromyography (EMG). It usually is performed by Physiatrists, i.e. Physical Medicine and Rehabilitation Doctor, or Neurologists with special training on the test.

NCV involves with mild to moderate electrical current stimulation at patient’s median nerves at the elbows and wrists of both side, then a computer will record the responses of the nerves and compare the velocity, amplitude and latency. By comparing with normal standard, also the patient’s left side median nerve with right side, your physician will identify injury at the median nerves if you have any.

EMG test applies a very fine needle into your muscles at the palm, arm and neck. The needle contains a microscopic electrode, which picks up both normal and abnormal electrical signals given off by a muscle. If there is nerve damage, the muscles supplied by the nerve will send out abnormal signals. Because median nerve originates from cervical spine, i.e. on the neck and go through entire arm and  lateral palm, therefore, some muscles will be examed with the needles.

The test usually will take about 30 min to one hour depending on how severe your condition and how extensive of a study your physician would choice. You may feel mild discomfort with the test, however, 99.9% of my patients easily take the test from my hand.

4. Blood tests may be performed to identify medical conditions associated with carpal tunnel syndrome. These tests include thyroid hormone levels, complete blood counts, and blood sugar and protein analysis. X-ray tests of the wrist and hand might also be helpful to identify abnormalities of the bones and joints of the wrist.

How is carpal tunnel syndrome treated?

Carpal tunnel syndrome can be classified as three types: mild, moderate and severe, depends on their symptoms and electrophysiological testing.

For mild and moderate cases, the following treatments are recommended:

1.      Immobilizing braces.  A wrist splint can help limit numbness by preventing wrist flexion, which might compress the median nerve.  The patient should wear a night splint, usually called a cock-up splint and the wrist should be hyperextended above 30 degrees.  Worn overnight for 7-8 hours, the nerves are rested and, in the morning, the patient feels much relieved and the symptoms will gradually improve.

Fig. 2.4

www.healthwise-everythinghealth.blogspot.com

2.      Physical Therapy

It is very important to improve mobility in the wrist flexors by means of stretching to rid of any restrictions and inflammation being placed through the carpal tunnel where the tendons of the wrist flexors and median nerve pass through.  To perform this stretch pull the fingers and thumb back to you with your palm facing away from the body.  This stretch for the wrist flexors can be progressed to placing the hand on a wall or a table.  A strong but comfortable stretch should be performed 2-3 times a day and held for 30-60 seconds.

Fig. 2.5

http://www.revolutionhealth.com/articles/stretches-to-ease-wrist-and-arm-fatigue/zm2290

In addition to stretching the wrist flexors, great research on Nerve Gliding has shown quicker decreases in levels of pain, increased grip strength, improved function, while decreasing need for surgery.  Patients performing Nerve Gliding Exercises underwent surgery over 30% less then those not performing the technique (Rozmaryn LM, Dovelle S. Nerve and tendon gliding exercises and the conservative management of carpal tunnel syndrome. J Hand Ther. 1998 Jul-Sep;11(3):171-9).

Fig. 2.6

http://daiseypt.com/articles/cts_conservative.htm

Modalities that have evidence behind them to effectively treat carpal tunnel are Ultrasound, Iontophoresis and Low Level Laser Therapy.  The American Academy of Orthopedic Surgeons recommends Ultrasound as a treatment option to assist with short and medium term benefits of carpal tunnel.  Iontophoresis with Hydrocortisone was very effective in mild and moderate stages of carpal tunnel.  Low Level Laser Therapy study results include decreased pain, numbness and tingling and improved function, grip strength, EMG results and patient satisfaction.

Fig. 2.7

http://ericksonchiropractic.com

Fig. 2.8

http://www.riversidechirorehab.com

Carpal Mobilizations have been shown to improve symptoms related to carpal tunnel.  A qualified physical therapist can perform such mobilizations to improve joint mobility and remove compressive joint forces off the median nerve at the thumb, wrist and elbow.

Fig. 2.9

 

http://www.rumsua.org/Upcoming_Book_.php

Other manual techniques with great research behind them in their effectiveness to treat carpal tunnel are categorized as bodywork or soft-tissue treatments.  Active Release Technique (ART) and Graston Technique are two such techniques fitting into this category.  Both ART and Graston showed improvements in mobility, strength and nerve conduction latencies at the wrist by working to remove restrictions and adhesions in the muscles and tendons of the wrist flexors. (Burke, Buchberger, et al. A Pilot Study Comparing Two Manual Therapy Interventions for Carpal Tunnel Syndrome. 2006.)

Fig. 2.10

http://www.sportfitrehab.com/ActiveReleaseTechnique/tabid/1356/Default.aspx

Fig. 2.11

http://www.therapytimes.com/content=0802J84C48768694404040441

Eighty-one percent of CTS patients in a private study attained

80 to 100% of decreased pain and increased function goals

in 10 treatments with the Graston Technique®.”

AOTA Annual Conference and Exposition [carpal tunnel syndrome poster presentation]. 2000 Apr. http://www.grastontechnique.com/Findings.html

Strength of the forearm muscles is important to assess.  With carpal tunnel there is an imbalance with the wrist flexors being predominantly stronger then the wrist extensors.  The wrist extensors must be strengthened to maintain balance to the forearm and wrist.  This will be accomplished by performing 2-3 sets of 10 repetitions with increasing levels of resistance bands or dumbbells.

Fig. 2.12

http://www.physioadvisor.com.au/8122850/wrist-strengthening-exercises-wrist-rehabilitati.htm

There is also great research showing the positive effect of Eccentric Strengthening Exercise to the Wrist Flexors to improve both Strength and Length of the muscle.  Eccentric Muscle Contraction is when the muscle is being activated while lengthening.  This would be performed by slowly lowering the wrist to the starting position over a period of 5 seconds for 2 sets of 10 repetitions.

Fig. 2.13

http://www.emedx.com/apex/apex_exercises/apex_wrist_flexor_strengthening.htm

It is also important to assess posture overall.  Many symptoms of carpal tunnel syndrome can be the result of improper posture at the shoulders and neck.  A few simple exercises to help correct any imbalances at the shoulders and neck should be part of the carpal tunnel program such as Shoulder External Rotation and Upper Traps Stretch.

Fig. 2.14

http://www.sportsinjuryclinic.net/

Fig. 2.15

http://www.wholistichealthworks.com/dealing_with_a_pain_in_the_neck.htm

Even with all the treatment approaches listed previously, if the underlying problem, such as inappropriate stresses placed to the body while at work, are not corrected the problem will resurface.  Physical Therapist also play an important part in educating the patient on proper ergonomics and even visit work sites to properly set up office spaces to ensure proper arm and wrist position.

Fig. 2.16

http://blog.scad.edu/bcasam20/2011/02/01/

Fig. 2.17

http://chirohealthwellness.com/custom_content/c_97882_sitting_survival_workshop_for_your_emplo.html

3.      Western medicine also uses nonsteroid  anti-inflammatory drugs such as Aleve and naproxen, or even some steroid drugs taken orally.

4.      Localized steroid injections.  Steroid injections can be used for mild and moderate forms of this syndrome, and are very effective for temporary relief. However, these injections are not recommended for severe carpel tunnel syndrome.

Fig. 2.18

www.aafp.org

5.      Acupuncture.  Acupuncture is also very effective for mild to moderate forms of this syndrome.  The points used are PC 7 Da Ling and PC 6 Nei Guang Usually after inserting the needles at these two points, it is effective to introduce electrical stimulation whose direction should be toward the fingertip.  The patient should feel the needle sensation radiating to the tips of the fingers and sometimes feels swelling and sore and experiences electrical shock to the fingertip.  This treatment is most effective three times a week for a month, while during the nighttime she should wear a cock-up splint for sleep.  Many patients get excellent results from the combination of these two treatments.

Table 2-1

Points Meridan/Number Location Function/Indication
1 Da Ling Pericardium 7 In the middle of the transverse crease of the wrist, between the tendons of palmaris longus and flexor carpi radialis Cardiac pain, palpitation, stomach ache, vomiting, mental disorders, epilepsy, stuffy chest pain in the hypochondriac region, convulsion, insomnia, irritability, foul breath, pain of the elbow, arm and hand.
2 Nei Guang Pericardium 6 2 inch above the transverse crease of the wrist, between the tendons of palmaris longus and flexor radialis Cardiac pain, palpitation, stuffy chest, pain in the hypochondriac region, stomach ache, nausea, vomting, hiccup, mental disorders, epilepsy, insomnia, febrile diseases, irritability, malaria, contracture and  pain of the elbow, arm and hand.
3 Qu Ze Pericardium 3 On the transverse cubital crease, at the ulnar side of the tendon of biceps brachii Cardiac pain, palpitation, febrile diseases, irritability, stomach ache, vomiting, pain in the elbow, arm and hand, tremor of the hand and arm.

Fig. 2.19

For severe carpel tunnel syndrome, surgery is the best option.  There are  two major type surgeries, i.e. open hand surgery and endoscopic surgery.
In carpal tunnel release, your surgeon cuts the tissue that holds joints together (carpal ligament) to relieve the pressure on your median nerve. You’ll have local or regional anesthesia, and you’ll usually go home soon after your surgery. Surgery usually results in significant improvement in your symptoms, but you still may experience some residual numbness, pain or weakness.

In endoscopic surgery, your surgeon performs carpal tunnel release through one or two small incisions in your hand or wrist using a device with a tiny camera attached to it (endoscope) to see inside the carpal tunnel.

Jessica underwent my treatment for a total of 12 visits and used a cock-up splint at night and rested her hand for one month without typing.  Gradually her symptoms lessened and she felt much less numbness and tingling sensation; her hands recovered their strength as well.

Tips for both acupuncturists and patients:

1.                              A clear diagnosis is necessary.  Some patients feel numbness and tingling in their fingers and hands without having carpel tunnel syndrome.  These sensations might be due to rheumatoid arthritis, osteoarthritis and other causes and if the diagnosis is not correct, the acupuncture and a cock-up splint cannot help.

2.                              The insertion of the acupuncture needles for the two points PC7 and PC 6 should not be too deep, about ½ inch, however, the electrical stimulation should be as strong as possible and as tolerable so it will bring enough energy to flow through the carpal tunnel and decrease the swelling of the hand.

3.                              I usually encourage the patient to wear the cock-up splint not only at night, but as much as is practicable during the day, while driving, doing housework, etc. which will greatly improve the patient’s rest on the median nerve and the carpal tunnel.

13: Acupuncture and Occipital Neuralgia

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

Dear Patients and Friends:

Happy New Year!

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

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

Best,

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


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

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

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

Rehabilitation Medicine and Acupuncture Center

1171 East Putnam Avenue, Building 1, 2nd Floor

Greenwich, CT 06878

Tel: (203) 637-7720

 

 

Case Discussion 13: Occipital Neuralgia


 

 

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

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

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

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

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

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

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

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

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

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

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

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

Tips for acupuncturists:

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

Tips for patients:

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

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