Browsing articles tagged with " headache"

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.

 

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

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

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

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

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

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

Progression of disease

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

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

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

Leprosy village people were celebrating the opening of the clinic.

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

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

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

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

49. Acupuncture and Post-Treatment Lyme Disease Syndrome

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

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

 

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

Robert Blizzard III, DPT

www.drxuacupuncture.co

Rehabilitation Medicine and Acupuncture Center

1171 East Putnam Avenue, Building 1, 2nd Floor

Greenwich, CT 06878

Tel: (203) 637-7720

Fax: (203)637-2693

 

Post-Treatment Lyme Disease Syndrome

My dear friends,

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

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

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

Jun Xu, MD

Recognize Acupuncturist as Healthcare providers

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

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

Thanks for your efforts and participating!

American TCM Society (ATCMS)

 

Fig 1-1

 

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

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

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

The main symptoms of PTLDS are listed as following,

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

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

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

 

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

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

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

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

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

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

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

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

 

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

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

 

 

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

 

 

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

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

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

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

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

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

Janet’s Treatment:

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

Tips for Patients:

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

Tips for Acupuncturists:

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

 

 

References

Reviews of human research

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

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

Non-human research

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

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

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

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

Reference resource:

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

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

 

 

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.

 

8: Acupuncture and Allergy and Sinusitis

Aug 25, 2009   //   by drxuacupuncture   //   Blog, Case Discussions, Uncategorized  //  No Comments

Dear Friends:

I assume you have had a wonderful summer. Now it is the time for our news letter 8 – allergy and sinusitis. If you think any of your friends or family members might be interested, feel free to forward this to them.  I hope your friends and you will enjoy it.

Best regards,

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


News Letter, Vol. 1 (8), August, 2009, © 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: Allergy and Sinusitis

header_pic

 

 

From: www.eyuyu.com/…/0618/20090618011745378.jpg

Dan J was a 16-year-old boy who came to me complaining of itchy and pinky eyes, difficulty breathing, headaches, and a runny nose which exuded yellow and green sputum for two weeks.  The patient had experienced these symptoms on and off for more than five years and they got worse  during the spring and autumn and better in the summer.   He was diagnosed with allergies which sometimes developed into sinusitis. He was given Allegra, benadral and other antihistamine medication.  At the beginning, this treatment helped, however, after about a week or two the medication stopped working. The patient was also given allergy shot with multiple antigens for more than one year. However, it seems not working too. His symptoms are very often developed to severe sinusitis headache, poor sleep and difficulty in concentration. His physician often has to prescribe antibiotics to prevent the infection further development. His mother is very concerned about the frequent usage of antibiotics, therefore today, he is brought to me. He reported he has all the symptoms listed above, with the addition of a minor outbreak of hives on his face and body.

Explanation of Illness

Allergies are an abnormal reaction to an ordinary, harmless substance called allergen.  They are many different allergens, such as pollen, dust, fur and mold.  When the allergens are absorbed into the body through inspiration or skin contact,  people’s immune system will have a chain reaction, and the white blood cells will produce IgE antibodies.  These antibodies attach themselves to mast cells which will cause the release of histamine and other potent chemicals.  This histamine will cause a spasm of smooth muscle on the respiratory tract, sinus, skin, ear and other body parts and then leading to runny nose, watery eyes, itching, and sneeze. If the sinus is infected with virus and bacteria, sinusitis occur and patients will feel sinus headache and fever.

There are three major sinus: 1. Frontal, 2. Ethnoid and 3. Maxillary sinuses, which are easily infected or irritated with allergens.

pic2There are five types of allergic reactions according to western medicine:

  1. Seasonal allergic rhinitis.
  2. Allergic rhinitis.
  3. Eczema (atopic dermatitis)
  4. Contact dermatitis.
  5. Urtcaria (hives).

Symptoms can be from mild to severe and are usually treated with antihistamines, decongestants, cortisone products (which might produce long ranging side effects), local chain modifiers which will block the effects of inflammatory chemicals and mast cell stabilizers.

 

Traditional Chinese Medicine (TCM) believes allergies and sinusitis are one disease with two different manifestations and stages.  In the first stage, the patient’s immune system is weakened.  When the weather changes, antigens, such as dust and mould increase and  invade the human body through the skin, mouth and nose, casing symptoms of the lung and the liver.   The symptoms of lung show shortness of breath and secretion from the sinus, the nose is the opening for the lung.  If there is allergen invasion from outside,  and  the patient’s body is not strong enough to combat it – especially if the immune system is in a weak state – the weak immune system will make the  lung symptoms worse.  This is why different people face the same allergen invasion and have different responses.  Most people are not allergic to dust, mould and the like.  They have no problem with allergens.  However, some people suffer from this condition because their immune system is weakened and their body energy is low, especially in the lung.  The liver function corresponds to the eye, i.e. the opening outlet of liver is eye. Therefore, if the lever function is low and weak, the eye symptoms such as itchy, pinky and tearing eye are more prominent.

Treatment Through Acupuncture:

Type 1:

  1. Allergic sinusitis.  We use LI 20 (Ying Xiang), which corresponding to maxillary sinus,  LI11 (Qu Chi), LI 4(He Gu) and GB 20 (Feng Chi).

Frontal sinusitis: add UB 2 (Zan Zhu)

Ethmoid sinusitis: add SI 18 (Quan Liao)

Pic 4-1

pic3

Table 4-1

chart4Notes: Please see news letter 5 for table 1 and Pic 1 series, news letter 6 for table 2 and Pic 2 series Newsletter 7 for table 3 and Pic 3 series  from www.drxuacupuncture.co for the location and photos of the acupuncture points.

Pic 4-2

pic5

Acupressure Tips for patients:

  1. The key acupressure points are LI 20, UB2 and GB14. You will feel your sinus opening by pressing the above points in both sides for 5 min of each and 2 to 3 sessions.
  2. Irrigating your sinuses with normal saline or some Chinese herbs solution might give you a significant improvement.

Acupuncture Tips for Practitioners:

  1. By electrical stimulation the points of LI 20 (Ying Xiang), UB 2 (Zan Zhu)  and GB 14 (Yang Bai), you may give patients a surprise that their sinusitis and headache might go away within one to two sessions, because the above points may increase the opening of the sinus and drain the sinus. The patients will feel “the pressure over the sinus” are much less after the treatment.
  2. LI 20 (Ying Xiang) is the outlet of the large intestine meridian and is adjacent to the nose, thus LI 20 connects the nose to the sinus after stimulation of the point. By stimulation of points of LI 20, UB 2 and GB 14, the treatment desensitizes the mucus membrane and decreases the amount of secretion. Hu Gu is the original location of the large intestine point, which can make the invasion of the allergen decrease and also will expel the allergen from the body. GB 20 (Feng Chi) will  enhance LI 4 (He Gu) of the  function to expel the invasion of the allergen.

Type II

For allergic eye symptoms we use GB20 (Feng  Chi ), LI11 (Qu Chi), LI 4(He Gu) plus the followings, St 1 (Cheng Qi),  St 2 (Si Bai), SJ 23 (Si Zu Kong) GB 14 (Yang Bai), GB 1 (Tong Zi Liao), UB 2 (Zan Zhu), UB 1 (Qing Ming), ST 8 (Tou Wei) and Ex-HN5 (Tai Yang).

For itching in the ear, add SJ 21 (Er Meng) and SI 19 (Ting Gong), GB 2 (Ting Hui).

See Table 4-2,  Pic 4-1 and Pic 4-2

chart6pic7Acupressure Tips for patients:

  1. For patient with itching ear and tinnitus, SI 19, SJ 21 and GB 2 are the best choice. You may press the above points for 3 to 5 min, 2 to 3 sessions per day for  2 weeks, you will realize the beauty of the points.
  2. For tearing and itching eye, GB 1, UB1 and St 1 are good choice.

Acupuncture Tips for practitioners:

  1. Electrical stimulations for SI 19, SJ 21 and GB 2 will greatly improve hearing, tinnitus and decrease the ear itching. You have to further differentiate the symptoms based on the patient’s body types,  there are two subtypes:
    1. Kidney Yang deficiency accompanied with symptom of cold in all 4 extremities, fatigue, and clean and long urine: add UB 23 (Sheng Shu) see Pic 3-1 and table 3-4.
    2. Gall Bladder fire excess accompanied with symptom of thirty, bitter in the mouth, inflamed eye, add GB 34 (Yang Ling Quan)  and Li 3 (Tai Chong).

Pic 4-3

chart8

  1. GB 20 (Feng Chi) ( See Pic 1-1 and table 1-1)  protects the patient from the allergen invasion and strengthens the immune function of the human body.  St 8 (Tou Wei) and Ex-HN5 (Tai Yang) are around the scalp, and will decrease headaches.

chart9Pic 4-4

pic10Initially Dan J underwent my treatment for four visits.   On his first visit, after about 20 minutes, his eyes were dry and his sinuses had stopped running, which made him happy and much more comfortable.   With three more treatments, his symptoms were almost gone. After discussing the case with his mother, Dan J came back for continued treatment, for a total of ten visits.  His problem was mainly due to a weakened immune system with deficiency of Kidney and Lung.  he needed acupuncture to help him improve these systems, thus casting off the effects of allergens on his body.

After subsiding his symptom, Dan was advised to return to my office during summer for about 12 visits, even then he did not have any symptom. After these treatments, Dan’s immune system was much strengthened, he only needed to come to me at the beginning of the next few  allergy seasons for five to six visits. Recently, however, his symptoms are so much improved, that he no longer needs to consult me, even at the beginning of new allergy season.

Tips for everybody:

“Strengthening your Yang in the summer, nourishing your Ying in the winter” is the wisdom of Traditional Chinese Medicine, which guides TCM practitioners for more than two thousand years. It means that the patients of allergy, sinusitis and asthma should be treated during summer for strengthening their Yang, i.e. immune system. The acupuncture points are UB 13 (Lung, Fei Shu), UB 15 (Heart, Xin Shu), UB 20 (Spleen, Pi Shu) and UB 23 (Kidney, Shen Shu). This is the reason  I requested Dan J came to my office during summer for 12 visits.

2: Acupuncture and Intolerable Headache

Feb 22, 2009   //   by drxuacupuncture   //   Blog, Case Discussions, Uncategorized  //  1 Comment

News Letter, Vol. 1 (2)

February, 2009

© 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 2: Intolerable Headache

September 28, 2008

Patient Name: Joan T.

學起來!5大穴道治頭痛,一分鐘立即舒緩

Joan T., a 16-year-old schoolgirl, was brought to me by her mother, because the girl had been suffering from headaches since she was 12 and first had her period. Her headaches were so severe that four or five days of the week during her period she was often not able to go to school. These headaches manifested themselves on both sides of the temporal area and also caused severe pain to the left eye. Because of the severity of the pain, Joan called her mother several days a week to pick her up from school, and the headaches were interfering with her school work. This made it necessary for her mother to quite her job and to begin to home school Joan, which she did for several years. However, at 16, Joan returned to high school as a junior in order to start preparing for the college entrance exams as well as apply to colleges. Her headache pain had become so severe that Joan was sleeping poorly, was extremely stressed, which often resulted in tears and depression, which made her eat too much, causing a large weight gain. Her mother had taken her to all kinds of doctors in hopes of alleviating her condition, but nothing helped, especially the drugs prescribed for Joan’s headaches. Her SAT exams were commencing in two months, at which point the mother finally brought her to me for evaluation.

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

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

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

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


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

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

A MRI of migraine patient

The causes of headaches are usually different.

The causes of tension headaches are usually caused by stress, muscular tension, and gouty arthritis on the neck or spine,

postural changes, vascular dilatation, protracted coughing or sneezing and fever and depression and temporal mandibular joint disorder etc.

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

The cause of migraine headaches is unknown either. It is very often. There is a family history of disorder and migraine headache can be triggered with many stimulants for example alcohol, weather,

altitude, exertion, food, and color and contrasting pattern, hormonal change, hunger, lack of sleep, medicine, perfume and stress etc.

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

Chinese medicine classifies headaches into two categories:

1.

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

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

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

2.

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

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

1,

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

2,

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

3,

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

4,

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

Acupuncture treatment for headaches:

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

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

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

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

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

  1. For Jue Ying (Liver) meridian headache usually the pain is on the top of the headand many time it connects to theeyes and frontal head. Du 20 Bai Hui, Liv 3 Tai Chong, Lung 7 Lie Que.

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

  1. Wind Cold: GB 20 Feng Chi, Extra Point Tai Yang , ST 8 Tou Wei, GB 8 Shuai Gu, UB 12 Feng Meng, UB 60 Kun Lun.

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

Personal tips for clinical use:

Acupressure tips for patients:

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

Acupuncture Tips for Practitioners:

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

5. Many headaches may be triggered by occipital neuralgia, trigeminal neuralgia, common cold, sinusitis and allergy etc. For those headaches secondary to the above, we have to treat the original trigger. We should treat the sinusitis, occipital neuralgia, trigeminal neuralgia, common cold, allergy, etc. If we can effectively treat the original trigger of the primary headache, our patient’s recovery rate will be much higher the average of acupuncturists. For many years, 99% of my patients felt much improved after my treatment because I notonly treat the symptom of headache, but I also treat the trigger factors.

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

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

Case Discussions