Monday, May 2, 2011

The Acupuncture Treatment of Muscle Atrophy


Chief Complaint: Fatigue, post viral muscle atrophy, arm pains along radial bones in both arms, extreme shyness
Western Diagnosis: Post viral syndrome, muscle atrophy.
Medical History: Male age 21, suffered sever CFS at age 13-severe fatigue, fevers, weakness, immune dysfunction. History of following hopefuls of herbs, vitamin/mineral protocols and biochemistry adjustments. The illness left him with the above mentions complaints. Particularly the atrophy of muscles of upper arms and back and upper body. Lower half of the body was strong.
Questioning exam: Patient: initially was too shy to look in the eye and so quiet in voice that it was at first difficult to get past the point of his only request which was to “feel better” and “have no pain” and then to be able to play basketball.
Pulse exam: Pulse: the yang positions were full and tense; the yin positions were particularly weak and deficient most notably the Kidney and the Liver pulse were almost imperceptible. Spleen and Stomach pulses were weak.
Tongue exam: Tongue: Red in color on the sides and tip. More pale purplish in color in the middle and paler at the root.
OM Diagnosis: Deficient Qi, Deficient Spleen and Stomach Qi. Deficient Yin of the Spleen. Deficient Kidney Qi.
Heat entrapped in the muscles of the upper back and arms due to deficiencies which caused the stagnancies of Liver Blood and Qi. Shen problem showing in the extreme shyness, and inability to look into my eyes- this shows some signs of Heart Shen and Liver Hun involvement. My assessment of this is the the blockage of energy, blood and nutrition to the muscles of the upper body included the nourishment of the spirts of the organs.
Deficient Lung Qi.
Treatment Principle: Build Qi and Blood through dietary adjustments to begin with to build the digestion and transformation of foods, fluids, qi and blood.
Build the Blood of the Liver.
Move the Qi to release trapped heat.
Build healthy qi to release stuckness in the muscle to address the pain patterns in the meridians involved in the Lung, Large Intestine, Small Intestine meridians.
Tonify and Nourish the Pericardium, Heart, Liver and Kidney Shens.
Build Yang Qi of Governing Vessel, and Shoayang Meridian Flow to Build Energies of Back.
Point Prescription: S.I. 3/UB 62: Open and build Governing Vessel and Tai Yang meridians.
GB 34 Bilaterally with GB 41, 40 and Liver 3: to Open Dai mo circulation between upper and lower body, support the tendons and muscles: along with L.I.4 for pain of 4Gates or 2Gates and the meridian of the Large Intestine.
LI 9, 10 build and clear trapped heat from the muscle.
GB 20/21 bilaterally.
UB 13, 43, 17, 18, 21, 22, 23
GV 4, 3, 8, 9, 14 with moxabustion
SP 6, ST 36 to build Qi.
Herbal Formula: Food as medicine: chicken soup, bone soup, some ginseng, astragalus.
Patient felt herb formulas made him ill… difficulty digesting complex formulas, therefore we based herbs on soups. Being much more classical in the herb-nourishing building department. Other “herbal” formulas included Oats, with dates, raisins, and almonds. This was and is an extremely sensitive, intelligent young man, studying mathematics at a top university.
Lifestyle Prescription: Over time this young man determined to become a vegetarian. So the chicken soups were adjusted to miso based, with sea vegetables, occasional additions to the soups of codonopsis, astragalus root, and red dates. As well as very green nourishing vegetable soups and beans. Particularly Kidney, adzuki, white beans.
Results: The results have been extraordinary.
The pain patterns subsided fairly rapidly. The upper body became stronger, he stood taller, coloring from pale to pink and health, he became engaged in conversations, making jokes, and the muscles of the upper back and back have begun to grow as well as the arms. The arms had pains from a lack of energy and from deficiencies and the gentle and gradual approach built him over time. This process was a year plus and is ongoing.
He now plays basketball on a team.
Continues to build energy, started yoga, got a good job and is otherwise a very healthy and postive man.
Synopsis: It takes process over a long time to make continued progress. The pain resolved fairly early in the course of treatment. The patient could have stopped there but in doing an ongoing process he has regained a level of development in the growth process which was delayed, atrophied due to previous illness.

The Acupuncture Treatment of Bell’s Palsy



Chief Complaint: Facial Paralysis
Western Diagnosis: Bell’s Palsy
Medical History: This 46 yr old female patient came to me with a recent case of Bell’s Palsy.(2 days). Complained of chronic low back pain, headaches, and a feeling of weakness for the last 3 months. Tried to eat conscientiousness but often had little to no appetite. too tired to work out because work schedule was too intense.Complained of being cold easily.
Questioning exam: Upon further questioning we discerned that she had much stress with her job. When asked if she felt that she had “support” in her life she admitted that that was precisely her personal complaint. (Low back pain can sometimes be an indication that the patient feels that he/she is unsupported).
Pulse exam: Pulse was thin, weak, particularly on the rear positions. Complexion was pale.
Tongue exam: Tongue was pale with a slight white coating.
OM Diagnosis: This facial paralysis was due to external wind invasion on a basis of kidney yang and qi deficiency.
Treatment Principle: Dispel facial wind, open Du to relieve back pain, tonify Kd yang and Qi
Point Prescription: Patient was given 2 needling sessions. Lv3,Li4 to open 4 gates and dispel facial wind. Because invasion was still active no local points were given in the face. Patient was then given Si3 and Ub 62 to open Du, dispel back pain. With St 36 to tonify Qi and far infrared at mingmen Du4 to tonify Kd yang. Ear seeds applied before the patient left at: uriculotempo nervous point, nervous system subcortex, Shenmen, and occiput.
Lifestyle Prescription: We discussed taking yoga classes to ease stress and relieve lower back pain and tonify internal strength. Discussed diet and supplements.
Results: Patient called the next day ecstatic. Facial paralysis almost completely alleviated, patient had first good night’s rest in months. No back pain. Coming back in 2 days for local facial points.

The Treatment of Facial Flushing and Hot Flashes with Acupuncture


Chief Complaint: Facial Flushing
Western Diagnosis: Hot Flashes
Medical History: This patient, (a male), complains of hot facial flushing. This patient complains of blurred vision which is worse when he is tired. He states that he is irritable, is easily disturbed by situations, and is easily frustrated. He states that he has a dry mouth, dry lips, and dry skin. He states that he has palpitations. He has perspiration on his palms and soles, He complains of not having time to exercise or time for recreational activities, He also states that he feels moody, and occasionally has a sinking feeling from his heart. The flushing is located on both cheeks and lower portions of his ears. The flushing is intermittent, it feels hot to the patient, and is warm to the touch. No other treatment or medication has been taken. This patient does not smoke, use drugs or drink alcohol. His diet consists of “fast foods” and sometimes he skips breakfast. His blood pressure is 120/90. His pulse is 66BPM.
Pulse exam: Pulse: Overall quality: weak, regular, slippery
Speed: 66BPM
Shape: Right, Cun: weak, Guan:slippery,
Qi: forceless
Left: Cun: weaker, forceless
Guan: slippery
Qi: forceless
Palpation: warm face, edema around eyes
Tongue exam: Body Color: dusky, a red-purple
redder tip and sides
red points in the liver area
Body Shape: swollen with scallops
OM Diagnosis: 1. Liver Qi stagnation: emotional
Symptoms: mood swings, frustration, repressed anger or resentment.
2. Spleen-Qi deficiency: swollen tongue with scallops, sleepy after eating lunch, sweating of palms and soles, puffy eyelids.
3. Kidney and Heart not harmonized: Palpitations, sinking feeling in the chest, tongue with a redder tip.
3. Kidney/Liver Yin Def.: malar flush, dry skin, dry lips, blurred vision, weak
pulse, red eyes
Treatment Principle: Root: Liver Qi Stagnation coupled with Spleen Qi deficiency. These two patterns are beginning to affect the heart and Kidney.
Spresd Liver Qi, Tonify Spleen Qi, Tonify Kidney Yin, Calm the Spirit
Point Prescription: Yintang: Calms the Shen
Ear Shen Men: Calms the Shen
Ren 17: Tonify Qi
Spleen 4: Tonifies the Spleen
Per. 6: Calms the mind
Liver 3: Sedates the Liver in excess patterns, subdues Liver Yang
LI 4: Combined with Liv. 3 to calm the mind
Kid. 3: Tonifies Kidneys
Herbal Formula: No herbal formulas were given
Lifestyle Prescription: One strategy for reducing psychological and physiological response to stressors is to learn relaxation techniques. A variety of techniques are effective, including meditation, visual imagery, progressive muscle relaxation, and self hypnosis. Practicing a relaxation technique can result in decreased activity of the sympathetic nervous system and reduced response to norepinephrin. For example, relaxation training has been shown to lower blood pressure in hypertensive patients, decrease the frequency of migraine headaches, and reduce chronic pain.
Results: This patient had excellent results after receiving six treatments.
Synopsis: Western Perspective: According to Western medicine, intermittent facial flushing (hot flashes) is associated with menopause. Due to the fact that this patient is a male I did some research to find another cause. I found that having to cope with stress, whether in the form of noise, infection, or even the anxiety of having to take a test can arouse the body to action. The brain and the adrenal glands work together to help the body cope effectively. The heart and respiratory rates increase, hands and feet become moist, the mouth becomes dry, the activity of the gastrointestinal tract decreases. The limbic system is involved with the emotional components, such as anger and irritability during the stress response.

The Use of Acupuncture and Herbs for Meniere’s Disease

Chief Complaint: Dizziness
Western Diagnosis: Meniere’s Disease
Medical History: 54 yo male with 15 year history of Meniere’s disease. Vertigo, tinnitus and hearing loss, vomiting when severe. Tried diuretics, salt restriction, conventional medications, all without benefit.
Questioning exam: Had not tried alternative methods. Has had recurrent severe episodes with increased severity. (Always has the basic symptoms, however).The frequency of severe attacks has steadily increased, from 1 per year to 6 this summer.Heat exacerbates the symptoms. He also has a feeling of fullness in his ears.
Pulse exam: Scalloped, normal color, thin white coat
Tongue exam: Slippery, kidney pulses weak
OM Diagnosis: Phlegm-Damp; congestion and stagnation. Damp spleen-kidney Qi vacuity
Treatment Principle: Warm and transform phlegm-damp, dispel wind and relieve dizziness.Fortify the spleen and boost Qi. Supplement the kidney and fill the brain
Point Prescription: Sp3 to strengthen the spleen, resolve dampness; ST40 to resolve phlegm/dampness; LI11 to resolve dampness; SJ3 benefits ear, expels wind, removes obstruction from channel; SJ5 benefits ear, removes obstruction from channel, indirectly subdues internal wind; SJ17 expels wind, benefits ear; SJ21 benefits ear; Sp6 strengthens spleen, resolves damp, tonifies kidneys, promotes function of liver; K3 tonifies kidney, benefits essence, benefits ear
Herbal Formula: Modified Wen Dan Tang (would have preferred Er Chen Tang but it was not available and the above is derived from this formula and was the most suitable)
Lifestyle Prescription: None necessary
Results: After 1 treatment and herbs, “fullness” dissipated. After 3 treatments, tinnitus and dizziness minimal. Anticipate a few more treatments for complete resolution.
Synopsis: 54 year old male with Meniere’s disease, increasing severity and frequency of symptoms. Conventional methods were not effective at all. Acupuncture and Chinese herbs have had excellent results.

The Acupuncture Treatment of Crohn’s Disease


Chief Complaint: Crohn’s disease.
Medical History: Crohn’s disease first diagnosed twenty years previous to first visit (patient 52 years old). Soon after a right hemi-colectomy was carried out, and about 40cm of Small Intestine including appendix and ileal sphincter was removed. About 16 years of relative health followed, after which disease progressed to include ulceration in the colon. Prognosis was for a permanent stoma, and the aim of treatment was literally to see if any improvement could be gained. At time of first consultation, patient was suffering from frequent sudden senses of pain and distension, followed by immediate need to evacuate bowels. This occurred 6-7 times a day, and included bleeding.
Other complaints included tiredness “similar to ME”, and “pimpliness” particularly on back shadowing the pathway of the SI channel on the left hand side, and between Bl19 and Bl19 across the spine. This was from long term steroid use. Patient was currently on 30mg predniselone.
Two months previous to consultation, px had suffered a gallstone attack, and doctor had recommended removal of gallbladder.
Patient’s appetite was good, and he was drinking roughly 3L of liquid (water & decaff) per day.
He had been a heavy smoker and drinker till about fifteen years previous.
He tended to sleep from 6-8pm, then wake until 2am, when he’d sleep till around 6am.
He considered himself to be an introvert. He worked as a designer in an engineering environment, and considered that he’d had to develop an extremely hard skin as a result. He said that he made his living “analysing things”.
Pulse exam: His pulse was generally soft, with particular emptiness at SI, Lu & LI, and TH positions.
His abdomen was generally soft and puffy, with particular areas of tension on the right hand side of the navel around St25 and below it towards the Ren line. The patient had a large scar from his operation on the Ren line skirting around the left hand side of the navel, extending from ensiform to pubic bone.
On his back, there was a significant area of discolouration just superior and medial to the right hand scapula – this was thirty years old, but had been checked and confirmed as being non-cancerous.
The gastrocnemius muscles were palpated for reactivity, but none was found.
Tongue exam: His tongue was a little red, with a thick white coat in the central and rear areas, and teeth marks on either side. It had a tendency to quiver.
OM Diagnosis: The assessment was applied through the Manaka yin-yang balancing model.
The patient was initially diagnosed for treatment using ion-pumping cords for Yangwei/Daimai Extraordinary vessel pairing to right side only.This was based primarily on abdominal findings.
Treatment Principle: Manaka’s five step treatment principles were applied. This incorporated, at every treatment the use of:
step 1 – ion pumping cords to one or two pairs of points
step 2 – “kyutoshin” (moxa on needle) to two or three pairs of points on back (generally shu points associated with ion pumping treatment points which exhibited reactivity to palpation
step 3 – in this patient’s case wasn’t applied.
step 4 – symptomatic treatment addressed at presenting problems, generally either light needling, “okyu” (direct small moxa pieces burnt to skin), and “chinetskyu” (large cones of moxa, burnt to just warm points)
step 5 – home therapy, and retained needles, comprising of self applied okyu to directed points and “hinaishin” intradermal needles retained for up to a week in SI auricular point and St27.
Point Prescription: The step one treatment varied over the ten treatments, including Yangwei/daimai, GB/Ht polar channel pairs, Ren/yinqiao mai, and Ki/LI polar channel pairs. There were significant pulse changes which were clearly evident from these treatments. The patient also reported subjective significant response to the okyu treatment, particular to the lower he/sea points, St37 & St39,which were applied each treatment from third onwards often unilaterally depending on reactivity. From treatment 9 the patient was instructed on home use of moxa to these points and encouraged to do this on a daily basis.
Herbal Formula: None
Lifestyle Prescription: None
Results: Improvements began to be reported after the second treatment. There was less bleeding in the stools, and there were “more good days than bad”. The patient was very encouraged by the early response (having initially committed himself realistically to a minimum of five treatments).
By treatment four, he was reporting that the severe diarhea had gone.
By treatment 6, energy levels were beginning to rise, and two week gaps between treatments were agreed. He also felt confident to cancel his appointment with his specialist (which implied further surgery) which had been scheduled for that week, and which he felt was no longer necessary.
At treatment 7 he was reporting slightly more tiredness.
By treatment 9 energy levels were again improving, there were now only 4 or 5 bowel movements a day, and negligible bleeding. Treatment ten was the last treatment – the patient was confident in use of moxa, and was feeling “better and better with more peace in my gut, with no blood”.
The patient canceled the next treatment, feeling that he was now managing his condition.
(Midway through treatment, incidentally, he referred his teenage daughter for acupuncture.)
There was only a very slight improvement to the pimples on his back, which became slightly less widespread, and particularly insignificant in the area between Bl19 and Bl19.
Synopsis: I was pleased with the response to a chronic condition, particularly his response to the okyu moxa to the lower he/sea points. Personally, I would have liked to have continued treatment for a further period of time to consolidate progress, but it was incontestable that his treatment goals had been met, and that, with the addition of home moxa techniques, he had not only found a way of avoiding further surgery but was finding ways to manage a condition that was unlikely to simply disappear.

The Oriental Medicine Treatment of Tension Headaches


Chief-complaint: Chronic Headaches
Medical-history: 54 year old female. Daily Headaches mainly tension-type occasional migraines with nausea.
Symptoms: tight neck and shoulders, tight-band sensation around the head, constipation, nightsweats, hot flashes, low libido
Pulse: thin/thready
Tongue: textbook yin-deficiency presentation: red body with no coating
OM-diagnosis: yin-def with heat
Treatment-principle: nourish yin, clear heat
Point-prescription: Tan-style Method
Shen Men (bilateral)
L: PC9, HT8, GB34, ST36
R: LI4, TB5, SP6, LV2.5, KD3
Herb-prescription:
Tian Ma Gou Teng Yin (Gastrodia and Uncaria Decoction) (morning, lunch)
Da Bu Yin Wan (Great Tonify the Yin Pill) (before bed)
Lifestyle-prescription: Told patient to work on posture, showed her doorway stretches, and told her to take walks and keep her eye-level at the horizon to promote better posture.
Results: After 1st treatment constipation improved. Better sleep/less nightsweats
No hot flashes after 2nd treatment
After 3rd treatment no nightsweats
Patient had only 4 headaches in the three weeks after I began seeing her. Two were self-induced with wine. One she got from being irritated by going to a “headache seminar” given by a specialist MD, I thought that was amusing.
Saw the patient 5 times and things seemed to good. She went from having daily headaches for the last 7 years to virtually none in a 6 week period.
My next project would have been the low-libido but she has not returned.
Synopsis: It was a pretty straight-forward case of yin-deficiency. I wish I had another 5000 cases like that one, it would make our job pretty smooth.

The Acupuncture and Herbal Treatment of Stomatitis and Conjunctivitis


Chief-complaint: Sores in the mouth and tongue, swollen, tender and bleeding gums, painful red eyes
Western-diagnosis: Stomatitis and Conjunctivitis
Medical-history: 38 year old male. Generally very stressed, works long hours, eats junk food almost every day and is always feeling hungry. Has some abdominal discomfort after eating. Usually very thirsty but can’t drink a lot of liquid. Has an odd sleep routine. Is usually constipated and has occasional burning of urine.
Symptoms: In the last 3 days is feeling feverish, constipated, has sores in the mouth and on the tongue, gums are tender, swollen and red. Eyes are puffy, and red. Temperature: 37.7 degrees BP: 130/90mmHg. Blood Sugar: 6.2mmol/l 50 minutes postprandial.
Pulse: Pulse is generally slippery and rapid
Tongue: Red tongue with slimy yellow fur and small ulcerations
CM-diagnosis: Stomach yin vacuity with damp heat
Treatment-principle: Clear heat and eliminate dampness, nourish the stomach and rectify the Qi
Point-prescription: St 4, St44, Sp6, REN3, UB21, LI4
Herb-prescription: Modified: Gan Lu Yin: Sheng Di, Mai Men Dong, Tian Men Dong, Shi Hu, Huang Qin, Gan Cao, Lu Gen, Zhi Mu, Pi Pa Ye, Tai Zi Shen. Colloidal silver mouth wash to which Ban Lan Gen was added, then to swallow.
Lifestyle-prescription: Adequate rest and relation advised. Exercise programme discussed but after settling of the acute stage of illness. Diet advise given especially to avoid sweet foods, fermented foods, acrid, hot, spicy foods, no alcohol.
Results: Patient was reviewed on day 4 after presentation. Mouth and Sores completely resolved. No eye problems. Bowel movements resumed but very loose. Generally much, much better.

The treatment of Myalgic Encephalomyelitis (ME, CFS) with Acupuncture


Chief-complaint: Lack of Energy
Western-diagnosis: Myalgic encephalomyelitis (ME) or chronic fatigue syndrome (CFS)
Medical-history: Female, 27 years old. History of depression, took citalopram (an antidepressant) a few years ago
Symptoms:
Frequently tired with low energy
Achy limbs and joints
Has to sleep in afternoon
Frequent frontal headaches
Dry skin
Floaters in vision
Dizzy on standing
Normally feels cold
Achy lower back
All symptoms worse for stress
Pulse: Pulse thin, deep and weak. Kidney positions very weak.
Tongue: Moist, slightly swollen and pale. Bright pale face.
CM-diagnosis: Qi and Blood Deficiency, some Kidney yang deficiency
Treatment-principle: Tonify Qi, Blood and Kidney yang
Point-prescription: St36
Kid3
Liv3
Ren6 needle plus moxa stick
Yintang if feeling stressed
Herb-prescription: None
Lifestyle-prescription: Keep warm, eat warm easily digestible foods.
Results: Began to feel more energy straight away. After 4 treatments she was having to sleep less in the afternoon. After 8 treatments she hardly ever had to sleep in the afternoon and had much more energy. Also felt less cold and ached less.
Synopsis: 27 year old female ME sufferer diagnosed with Qi and Blood deficiency. Treated with acupuncture and moxa, with good results.

The Acupuncture and Herbal Treatment of Infertility Due to Hyperprolactinemia




Chief-complaint: Infertility
Western-diagnosis: Infertility, hyperprolactinemia
Medical-history: 34 year old, female. She had taken contraceptive pills since she was 18. Stopped around June 2009 when she and her partner wanted to start a family. No pregnancy so far. Has history of cystitis.
She had some tests in January 2009, which showed that she had hyperprolactinemia (PRL: 1030mu/L) and she had no ovulation.
Symptoms: Thought & worried too much, tend to catch cold, preferred warm drinks, extremely cold hands and feet, even needed to wear thick cotton socks in the summer, insomnia, had difficulty in falling asleep, severe constipation (once a week), occasional abdominal distention and acid reflux.
Her cycle was 29-35 days, period lasted about 5 days, had period pain on the 2nd day, normal amount, red color with clots. Last period was on 30/12/2008.
Pulse: wiry and thready
Tongue: pink tongue with red tip, yellow and thick root
CM-diagnosis: Yang deficiency, coldness in blood, liver qi stagnation
Treatment-principle: Tonify Kidney Yang, Warm channel and disperse cold, sooth Liver qi
Point-prescription: guanyuan (RN4), zhongji (RN3), taixi (KI3), taichong (LV3), zusanli (ST36), sanyinjiao (SP6), sishencong (EX)
Herb-prescription: Yu Lin Zhu & Dang Gui Si Ni Tang & Chai Hu Shu Gan San modified
Lifestyle-prescription: Avoid cigarette, alcohol, coffee
Results: Treatment started in mid-January, by the beginning of April (3/4) she is pregnant. And a beautiful baby girl was born in Dec 2009.

Acupuncture Treatment for Scar Tissue


Chief-complaint: Arm numbness & weakness due to trauma
Medical-history: A right-handed young man (~21), seen & treated at a volunteer shift at a homeless youth drop-in service center. We’ll call him Amadeus.
About a year previously, Amadeus got in a fight & was stabbed in the left arm, and then thrown in jail where he received almost zero medical attention. He had one wound up in the deltoid, and a more serious one about halfway up the ventral forearm. This trauma seems to have nearly severed his extensor digitorum (while he was in jail, he couldn’t move or feel his fingers). About 4 months after the initial injury, he had surgery to repair the injury.
Symptoms: When I saw him, he had a large (about 8”) crooked scar on his forearm; the initial knife wound had a deep scar at the center, & there are 2 surgical scars extending out from it. Here’s my graphical interpretation:
The scar was raised & thick (about ¼” – ½” wide), not keloid, and colored reddish-pink to purplish in the center. The central scar was painful with or without touch and dented into the landscape of his arm; the other scars were sometimes painful. He complained of pain in the scar & fingers, numbness & lack of strength in the hand (his grip strength rated about 50% weaker than the right), also his hands tended to get cold easily. (He was also a smoker.) He was trying to do exercises with this arm; and also played guitar so was using the fingers extensively.
CM-diagnosis: Blue Plate Special (qi & blood stagnation in the jingluo)
Treatment-principle: Open channels, scour out stagnation & use a lot of moxa to restore function (to get qi & blood moving from around & outside the scar areas)
Point-prescription:
L.I. 11 or 10 (depending on sensitivity)
Baxie
L.I. 5
Lu7 (pointing into the hand)
SJ5 or SJ4 (SJ=San Jiao = Triple Burner = Triple Energizer)
ashi points along the scar (4-5 needles along the scar obliquely angled in towards it)
For the deltoid scar: 4 needles pointing into the deltoid scar & L.I.-15.
Plus used indirect moxa along the length of the scar.
Most importantly, I gave him a moxa stick for self use at “home.”
Lifestyle-prescription: Strongly lectured him about cigarette’s impact on peripheral circulation.
Results: Beginning with the 2nd treatment, major scar improvement! The color changed to lighter, there was less pain, & arm overall more stronger.
He reported that the Lung/Pericardium channels felt “buzzy & squiggly”. Forearm scar felt much less tight, less swollen aspect (primary stab wound had a dense swollen feeling). Scar palpation elicited less pain, and the feeling of the scar was of a mild stickiness (not so dense as previous). also there were distinct hollow areas on each side of the original stab wound.
~ 3 months later: Due to the informal nature of this treatment site, I mostly had only treated him 1x/month. However, he had been very consistent in self-use of the moxa sticks.
His arm pain was very reduced, arm stronger & the scar had changed color to only slightly darker than the rest of the skin on the arm. (In contrast, the deltoid scar which had rarely been treated, was still a dark purple-red color.)
Synopsis: When treating trauma, ALWAYS consider using moxa!

The Treatment of Vomiting with Chinese Herbs


The Treatment of Vomiting with Tiao Wei Cheng Qi Tang (Regulate the Stomach and Order the Qi Decoction)
by Dr. Wang Chang-Yong 王常勇
Patient: Wan, female, 32 years old.
Chief Complaint: vomiting
Medical History: Ms. Wan suffered for a long time from low-grade fever, chest pain and cough. The respiratory department in the hospital diagnosed her with pulmonary tuberculosis, and after receiving treatment, she was all better.
But five days ago she started to vomit, gradually worsening, with many bouts each day; she vomited after eating, and had difficulty eating and drinking. She self-administrated some Western medicine sedatives and anti-emetic drugs but without any results. Then she sought care from a Chinese medicine doctor.
First examination took place on April 28th 1984.
Her state of mind was mildly depressed. Her body was thin and weak. She had a flushed red complexion and was feverish. She did not want to eat or drink, and frequently vomited – including immediately after eating.  She said that since she started to vomit 6-7 days ago, she had not had a bowel movement.
Tongue Appearance: her tongue body was red with a slightly yellow, greasy coating.
Pulse: her pulse was wiry, thin and rapid.
CM Diagnosis: because the disease is chronic, her body was thin and weak; the interior heat had damaged the yin, there was clumping heat in the middle jiao, the qi of the fu organs was not moving, the Stomach qi not descending, and turbid qi was rebelling upwards.
Treatment Principle: the suitable treatment was to unblock the bowels, and descend the rebellious qi.
Formula: tiao wei cheng qi tang with dang gui (Regulate the Stomach and Order the Qi Decoction with added Angelica Sinensis)
da huang (Radix et Rhizoma Rhei) 10g (added at end)
mang xiao (Natrii Sulfas) 10g
gan cao (Radix et Rhizoma Glycyrrhizae) 15g
dang gui (Radix Angelicae Sinensis) 15g
Instructions: Decoct one package, and drink small amounts frequently.
Results: The patient finished drinking the formula before going to bed at night, and she did not vomit between drinking doses; she slept calmly through the night, woke up early in the morning, and had a watery bowel movement. Her abdomen felt comfortable, her feverishness had subsided, her mouth was dry and she felt slightly thirsty. She ate half a bowl of porridge, drank a small amount of water, and did not vomit afterward.
Synopsis: the reasons for vomiting in this case were blockage of the qi in the fu organs and rebellious Stomach qi. The doctor chose a purging treatment principle based on the saying “use unblocking method to treat disorders of the fu organs” which also agrees with the saying “choose purging when treating diseases that are in the upper part of the body.” In considering a chronic disease with a yin-deficient type of body, and with middle jiao damage to the fluids with clumping heat, it is inappropriate to strongly purge so therefore the doctor added dang gui to the modified formula tiao wei cheng qi tang to tonify the yin, nourish blood, protect the normal qi, moisten the intestines, and gently purge the pathogen. The direction to frequently drink small amounts of the decoction benefits and restores Stomach qi. This gradual intake therefore aids to rid the heat via purging, the qi follows the unblocking motion of descending, and therefore the qi stops rebelling and the so does the vomiting.
Originally published at Hei Long Jiang Chinese Medicine Journal 1986, volume 4, pg 49.
Source: shang han ming yi yan an jing xuan – selective shang han lun case studies of famous doctors, pg 294
Xue yuan chu ban she – Xue Yuan publishing house, beijing, 1998

Chinese Medicine in the Treatment of Shoulder Pain


Chief-complaint: Right Shoulder Pain
Western-diagnosis: inflammation of the deltoid
Medical-history: 64 year old female.
Complaining of shoulder pain x 1 month.
Symptoms: Right shoulder pain
Pain with arm abduction
Forward flexion pain
Pulse: Wiry
Tongue: tongue- Liver Stagnation/ heat
Purple engorged veins
CM-diagnosis: Blood & qi stagnation in the LI and SJ, Kid qi
Treatment-principle: Move blood and qi, tonify kid qi, smooth liver
Point-prescription: bleed LI-1, SJ-1
Ashi point opposite side of pain.
Electric stimulation.
LI-11 to LI-15
SJ 5 to SJ-14
St-38 %
SI 3
UB 62
Sp 10
Herb-prescription: Dang gui
Rou gui
chuang xiang
yan hu suo
yu jin
xiang fu
chai hu
du huo
zhi zi
du zhong
Lifestyle-prescription: No exercise,
Ice 15 min
Heat 15 min
acupuncture 3 x a week
Results: 1 month of treatment
3 treatments per week.
All inflammation cleared up and movement 100% better.
I saw patient 1 x a week for 1 month as a follow up
Synopsis: Bleeding helped o relieve the stagnation.
Movement of the affected arm while needling ashi point opposite side was very helpful for range of motion.
Blood/ Qi Liver Stagnation and Kid Qi def was treated via herbs and acupuncture


Oriental Medicine Treatment of Rosecea


Chief-complaint: Rosacea
Western-diagnosis: Rosacea
Medical-history: Patient was a 36 female who first came in for fatigue. Patient has premenstrual anxiety, breast distension and diarrhea.
She has cramping and pain with period. She reports she is under a lot of stress. She does drink wine and coffee daily. Also, she likes spicy food.
Symptoms: Rosacea started in January with red cheeks and nose. Went to dermatologist and tried over-the-counter herbal remedies (Women’s Balance) which helped some, but got worse in August of that year. Red, itchy slightly raised papules closer to eyes. Worse during and prior to period. Her skin is now oily. She is not sunlight sensitive.
Pulse: wiry & strongest in left guan, weaker and slightly slippery in right guan. Weakest both cubit especially the left.
Tongue: Fat, slightly pale tongue with yellow coat in center.
CM-diagnosis: Heat in the Stomach and Lung
Treatment-principle: Clear Heat from the Stomach and Lung
Point-prescription: LI-4, ST-44, SP-6, CV-12, Yintang, Tai Yang (on left) added SP-9 and HT-7 later.
Herb-prescription: Lian Qiao 12,Huang Qin 12, Jin Yin Hua 12, Chai Hu 9, Dang Shen 9, Ban Xia 9, Mu Dan Pi 9, Chi Shao 9, Huang Lian 3, Gan Cao 3
Lifestyle-prescription: Stop drinking wine and coffee, especially on a daily basis. Stop or at least cut down on spicy and hot foods.
In other words adhere to a clear bland diet. Get more exercise Do relaxation: Qi Gong or Tai Qi
Results: Patient took granules at a dose of 12g per day for one month. Patient also changed her lifestyle. She gradually got much better and hasn’t had this problem since (that is 6 years ago).
Synopsis: Eating hot, spicy foods and drinking alcohol was engendering heat in the stomach. Patients premenstrual tension was a result of liver attacking spleen and stomach which created more heat in the stomach.


Acupuncture Treatment of Recurring Nightmares


Chief Complaint: Recurring Nightmares
History: Patient was an 23yr old female who had no previous major medical history. She had a tonsillectomy when she was in grade school (did not remember age) . No medications, no history of abuse and could not think of any specific physical or emotional trauma.
Symptoms: Recurring dream of being chased then strangled. Initial onset was about 1.5 months prior to tx with an occurrence about 2/3 times per week. Patient was having difficulty sleeping due to anxiety about having nightmare and would sleep very lightly. After dream would usually stay up about 2 hours to calm herself down. All other functions seemed normal.
Palpation: Thin and thready. Weakness in Ht and Sp position.
Observation: Tongue N/A
Abdominal palpation showed large pulse in Ht area, softness in Sp area
OM Diagnosis: Ht & SP QI and BL def
Treatment Principle: Tonify QI and Bl, Calm Shen
Point Prescription: Tx1: Sp4 PC6, LU 7, Ki 6, Du 20
Tx2: Ub13,14,15,18,20,23
Tx3: Du20, UB11, Ub23, Ub61
Herb Prescription: None
Lifestyle Prescription: Recommend abdominal breathing for at least ten cycles while in bed before falling asleep.
Results: Patient reported fewer nightmares after first tx and sound sleep. Second treatment a week later. After treatment patient reported sounder sleeping no nightmares, but did wake a few times feeling slightly upset. Third tx was two weeks later and reported no more dreams after.
Synopsis: The patient had been relatively health with some minor stressors, which were found out during the fourth treatment. She had been worrying about going to grad school which seemd to coincide with the nightmares


The TCM Treatment of Lyme Disease


Chief-complaint: Recurring fatigue and joint pain for eight years
Western-diagnosis: Lyme disease
Medical-history: A 46 year old Caucasian male with a history of recurring fatigue and joint pain that would leave him bedridden. He received steroids for the initial bouts which relieved his symptoms temporarily. Many years later, he was diagnosed with Lyme disease and given approximately 8 weeks of antibiotic treatment. Patient reported little improvement with the antibiotic therapy.
He came into my office after being unable to work for several months. He reported extreme fatigue, brain fog, and severe pain in his right ankle.
Symptoms: Extreme fatigue, brain fog, ankle pain.
Pulse: Pulses were thready, sinking, and slippery.
Tongue: Tongue was purple-red with a white-yellow moist coat.
CM-diagnosis: Qi and blood deficiency with damp-heat toxins / Gu Syndrome
Treatment-principle: disperse gu toxins, kill pathogens, calm spirit, tonify and move qi and blood
Point-prescription: Tonify KI10, LIV8. Moxa on KI3, SP6, ST36. Wet cupping on left ankle, shoulders, and base of the neck.
Herb-prescriptions:
Formula 1: Chuan Xin Lian, Hu Zhang, Lian Qiao, Qing Hao, Ren Dong Teng, Tu Fu Ling, Yu Xing Cao, He Zi, Gou Qi Zi, Xu Duan, Niu Xi, Cao Wu, Shi Chang Pu, Yuan Zhi, Di Long, Mu Li, Long Gu
  • 6 grams of powdered herbs taken in water three times a day for 10 weeks.
Formula 2: Bai Hua She She Cao, Bai Shao, Da Qing Ye, Dan Shen, Dong Chong Xia Cao, Huang Bo, Huang Lian, Jin Yin Hua, Kun Bu, Ling Zhi, Rou Gui, Hua Jiao, Zhi Zi
  • 4 grams of powdered herbs taken in water two times a day for 10 weeks.
Formula 3: Lian Qiao, Huang Qin, Ren Dong Teng, Ban Lan Gen, Da Huang, Pu Gong Ying, Zi Hua Di Ding, Chuan Xin Lian
  • 4 grams of powdered herbs taken as needed for herxheimer reactions.
Lifestyle-prescription: Eliminate cow dairy, wheat, refined sugar. Add more lean animal protein, seaweeds, raw and cooked greens, no alcohol or caffeine. Burned Ru Xiang every evening before bed.
Results: Patient received weekly treatments of: acupuncture, detoxification, craniosacral technique, wet cupping, and Sufi healing.
First treatment: the patient reported that their ankle pain was gone completely.
Second treatment: the patient reported feeling much less fatigue and returned to work.
Third treatment: patient reported being able to work 60 hours and had some bouts of fatigue.
After 10 weeks: the patient reported being symptom free.
Follow up after one year post treatment: patient still reports being symptom free.
Synopsis: Lyme disease is a chronic infection which requires a multi-pronged strategy for detoxification, eliminating the pathogen, rebuilding the immune system, and resolving pain, fatigue, and neurological symptoms.
Using a Gu Syndrome herbal approach as outlined by Dr. Heiner Fruehauf was a critical component to successfully eliminating the patient’s symptoms.
Sufi healing methods were used to expel “bad spirits”. This methods produced dramatic reductions in pain, fatigue, and brain fog.
Wet cupping was also used to quickly drain toxins and resulted in rapid increases in energy and mental clarity.

Acupuncture Treatment of Parkinson’s Disease

Chief-complaint: tremor
Western-diagnosis: Parkinson’s Disease
Medical-history: 75 year old male has been diagnosed with Parkinson’s Disease 8 years ago.
Symptoms: This patient is a 75 year old male with tremors in both hands and generalized weakness and fatigue throughout his whole body. This started 8 years ago, with severe and sudden weakness in muscles so that he was unable to walk. Hand tremor started 5 years ago. Patient is unable to walk further than five minutes without feeling weak and short of breath. Hands tremor constantly and he is unable to write.
Body temp: cold with cold hands and feet
Lungs/Heart: shortness of breath with little activity. no palpitations.
Digestion: No appetite, little thirst. Prefers warm drinks. Bowel movements 1 time per day. Formed soft.
Slight dizziness; difficulty keeping equilibrium.
Sleep: Good. Sleeps 12-14 hours a day. Very fatigued.
EENT: no phlegm, tinnitus almost constantly.
Urination: frequent, once an hour, 3-4 at night.
Energy Level: very low “2 out of 10″
Emotions: sad, discouraged, angry.
Pulse:
Right side
cun: deep, weak
guan: frail, forceless
chi: deep, weak, almost absent
Left side:
cun: deep, thready
guan: thready
chi: absent
Tongue: Color: pale, slight purple, slight red tip
Body: “flabby”, scallops
Coat: Thick, white in the back, otherwise, thin, white.
CM-diagnosis: Kid Yin/Yang Xu with Liver Blood Xu leading to Liver Wind
Treatment-principle: Extinguish Liver Wind, Nourish Liver Blood and Kidney Yin, Tonify Kidney qi and yang
Point-prescription: Lower jiao zone on scalp (3 needles near Du 20)(stimulate vigorously throughout treatment), St-36, Lv-8, LI-4, Lv-3, Kid-3, Kid-6, Sp-6, Ht-7
Herb-prescription: This patient was unwilling to take herbs, but I wanted to try Bu Yang Wang Wu Tang with him.
Lifestyle-prescription: Rest with short walks.
Results: While needles were in, patients tremor stopped. After needles were removed, patient still had no tremor and was able to write, something he had not been able to do in several months. He wrote smoothly, without tremor disrupting his handwriting. Patient’s relief lasted 5 days, then he felt he needed another treatment. The next treatment, he did not have the same effect, he felt he was more fatigued, “wiped out”. Patient received a third treatment, that again, improved his tremor and his energy. Patient never returned for additional treatments after this.
Synopsis: Patient presented with severe fatigue, muscle weakness and tremor in hands. Patient had a diagnosis of Parkinson’s Disease and had exhausted all Western medical avenues. Patient received scalp needling for the low jiao (a technique I learned from Hong Jin of the Oregon College of Oriental Medicine), as well as points to support his TCM diagnosis of Kid Yin/Yang Xu, Lv Blood Xu generating Lv Wind. Patient’s tremor improved tremendously with this point combination, but outcome is uncertain because patient only received 3 treatments, then did not return.

Epidemic Cholera treated with Acumoxa Therapy


Chief-complaint: Diarrhea
Western-diagnosis: Cholera
Medical-history: In flood affected areas in Pakistan, gastrointestinal Disorders are very common. Diseases such as diarrhea, dysentery, vomiting, and colic to mention just a few.
Symptoms: Watery diarrhea, feelings of fullness, cramping pains.
CM-diagnosis: Excess type diarrhea
Treatment-principle: sedate spasms, tonify immunity
Point-prescription: Du 20,
Ren 4, 5 & 6
St. 25, 29, 36, 37 & 39
Li 4 & 11
U.B 25
Sp 4 & 6
Herb-prescription: Homoeopathic and allopathic medicines are being provided where available.
Results: We have tried acupuncture treatment in such cases and got very good results. Even without needling many patients are being treated with laser and electric pulse treatment at the specific acupuncture points. Moxibustion is also very helpful.
In flood affected areas, the diarrhea in children is of Excess type and we are providing Sedative treatment for controlling acute gastro-enteritis, feelings of fullness, cramping pains etc. In such cases we have experienced the specific points treatment along with immune enhancing points proved fruitful.
Synopsis: The members of Acupuncture Promotion & Welfare Society includes medical doctors, homoeopathic doctors and acupuncturists are serving the flood victims to the accessible areas under supervision of Dr Javed Iqbal Ch, The President, Acupuncture Promotion & Welfare Society (APS) Pakistan.

Acupuncture Case Studies - Treatment of Infertility



Chief-complaint: Infertility
Western-diagnosis: Unexplained Fertility
Medical-history: 27 year old female, unexplained infertility. Had been trying for four years to become pregnant. Active and fit.
Symptoms: Mild to moderate stress, depression and anxiety related to work and not getting pregnant.
No complaints of pain
No other remarkable symptoms.
Pulse & Palpation: Pulse wiry. Tender to palpation low back and SI joint. Very tight abdominal muscles from exercise routine.
Tongue: Tongue normal size and shape, slight dusky, with thin white coating. Physical exam revealed anterior R hip rotation.
CM-diagnosis: Qi and Blood Stasis, Liver qi stagnation
Treatment-principle: Move Qi and Blood, smooth Liver
Point-prescription: Supine treatment for 20 minutes: 4 gates, GB27,KI20, P6. Then prone, using UB15, UB17, UB18, UB23, UB25, UB29, UB31, UB32, plus ashi at SI joint. End of treatment used Tui Na and handheld electric stimulation on low back.
Herb-prescription: None
Lifestyle-prescription: Instructions on breath-work to relax abdominal muscles, stop caffeine.
Results: After four consecutive weekly treatments using this or slightly varied protocol, patient became pregnant.
Synopsis: Most cases of infertility involve kidney and spleen deficiencies and/or liver qi stagnation, but the primary reason for this patient’s inability to conceive was primarily due to a lack of blood circulation in the pelvic region. Once the pelvic rotation was corrected and back and abdominal muscles relaxed, she quickly became pregnant.

Acupuncture Case Studies - Treatment of Insomnia



Chief-complaint: Insomnia
Western-diagnosis: Insomnia
Medical-history:
Symptoms: Insomnia with racing thoughts, worry, tossing & turning during her few hours sleep, fatigue, poor memory, & anxiety.
Pulse: Thready, slightly rapid
Tongue: Pale slightly Thin, w/slight white coating in middle jiao.
CM-diagnosis: Insomnia due to Heart & Spleen Deficiency
Treatment-principle: Supplement the Heart and Spleen to promote the production of Blood and Qi
Point-prescription: Initial Acupuncture:
Front: Ht 7, Sp 6, An Mian, GB 20, Kid 6, UB 43, UB 20, Du 20
Auricular: Shen Men, Sympathetic
Herbs: Gui Pi Tang 5:1, 5ml 3x daily
Upon Reviewing Practical Therapeutics of TCM, I decided to use only the auxiliary points, Du 20, UB 52 & Si Shen Cong. I also discontinued the Gui Pi Tang.
Herb-prescription: Herbs: Gui Pi Tang 5:1, 5ml 3x daily
Discontinued after reassessment during third visit.
Lifestyle-prescription: Avoid vigorous exercise after 5pm and stimulating mental activities after 8pm. Try to avoid heavy or spicy food at night as well. Do not work or watch TV in bed. Use your bed for sleeping only.
Results: At first glance, this seemed to be a very easily treated condition. Unfortunately, the patient was unresponsive to the first three treatments.
Upon Reviewing Practical Therapeutics of TCM, I decided to use only the auxiliary points, Du 20, UB 52 & Si Shen Cong. I felt that I while the condition was accurately diagnosed as a Heart/Spleen deficiency pattern, the treatment should focus on WHERE the symptoms manifest, in the head. I discontinued the Gui Pi Tang for the same reason.
The following day, the patient called to tell me that she finally had a decent night’s sleep. I treated her 8 more times with Si Shen Cong, Du 20, and UB 52. Patient went from 3-4 hours of fit-full sleep to 6-7 restful hours per night. Her fatigue resolved and her memory improved.

Acupuncture-Assisted Anesthesia

ABSTRACT
   The history, mechanisms, and clinical applications of acupuncture in the anesthesia setting are addressed herein. Special emphasis is placed on the role of acupuncture in pre-operative preparation of certain types of patients, intra-operative application of acupuncture-assisted anesthesia, and post-operative management of surgical and anesthesia complications. Advantages of acupuncture analgesia and other symptomatic control, functional maintenance and restoration, reduced mortality, and acceleration of discharge are further explored.
KEY WORDS
   Acupuncture, Anesthesia, Peri-Operative, Pre-Operative, Intra-Operative, Post-Operative
INTRODUCTION
Acupuncture and Modern Medicine
   The clinical efficacy of acupuncture has been reviewed elsewhere. The scientific merits and physiological phenomena achieved through acupuncture have been demonstrated through the use of various types of advanced technologies,1-5 including myoneural electrophysiology studies, radioactive tracer survey and imaging, and single-photon emission computed tomography. Other research, including thermographic studies and studies of kinesiology phenomena, have demonstrated clinical and physiological responses to acupuncture, although the findings remain controversial.
   The growing acceptance of acupuncture is undeniable as seemingly greater numbers of physicians begin to take interest. The National Institutes of Health currently endorses the application of medical acupuncture in many areas. Since February 1996, the Food and Drug Administration has classified acupuncture devices as general medical, rather than investigational, devices.
PRE-OPERATIVE PREPARATION
WITH ACUPUNCTURE

   The primary goal of using acupuncture pre-operatively is to complement and enhance the medical preparation rather than to replace it. Acupuncture preparation of a patient for surgery does not replace a sound medical evaluation and diagnostic testing whenever indicated. Assessments should be made of the potential surgical structures, co-existing anatomical and physiological abnormalities, general physical condition, and the patient's psychological and socioeconomic status. Energetic and meridian conditions must also be addressed. Normalization or optimization allows the patient to safely undergo surgery and recover uneventfully.
During this phase of acupuncture application, the principles used are primarily meridian regulations, optimization of physiological function, and enhancement of endogenous opioid activities for the immediate pre-operative period.
   Korean Hand Acupuncture, Auricular Acupuncture, and a short form of either Traditional Chinese Medicine (TCM) or French Energetic Acupuncture are the most applicable techniques during the pre-operative period. Two of the most commonly applied examples are:
Cardiac Patients
  • Korean Hand Therapy (KHT):12 Shu Mu, Pericardium, KA 18, and KI 11 Shu Mu, Heart, KA 16, and KI 12
  • Auricular Acupuncture: Heart and Kidney points3,29
  • Distinct Meridian: BL 1, SI 10, and HT 1 (K, HT points could be an alternative approach)1,12
  • TCM pattern diagnosis and prescriptions2,3*
  • French Energetics: Shao Yin and Tai Yang regulation, or Distinct Meridians1*
  • Japanese Meridian Therapy30*
    *Constitutional balance

Pulmonary Patients
  • KHT12
  • Auricular Acupuncture: Lung1, 2, Asthma1, 23,29
  • Distinct Meridian: LI 15, LU 1, LI 18, KHT corresponding points. KD 11, KC 1, KD 19
  • TCM 2,3*
  • French Energetics1*
  • Japanese Meridian Therapy30*
    *Note: Items with an asterisk should be applied only by physicians well-trained in those areas.
   Recommendations for the pre-operative acupuncture preparation of patients are primarily safety, simplicity, short-term improvement oriented, and minimal duration. Acupuncture is to be used particularly for cardiac and pulmonary patients who are receiving maximally-tolerated medical treatments and still remain dyspneic, having chest pain, etc. For other symptoms associated with the surgical target, i.e., pain and nausea/emesis, acupuncture should be used only if necessary.
   Other co-existing diseases (diabetes mellitus, for instance) appear to be minimally indicated in acupuncture pre-operative preparation. The patient's blood glucose level usually can be controlled satisfactorily within hours with a computerized insulin pump. Use of acupuncture in this type of case appears redundant and unnecessary.
In other medical conditions including seizure disorder, coagulation disorder, or blood loss, acupuncture should not be used to replace medical treatment; there appears to be little value in the enhanced medical effect of acupuncture within the short pre-operative period in these areas.
INTRA-OPERATIVE PREPARATION
WITH ACUPUNCTURE

Principles of Acupuncture Surgical Analgesics
   Acupuncture does not produce a true anesthesia in any form; it does, however, have a profound analgesic effect and produces sedation.2,8,13-18
Enhancement of Endogenous Opioid Activities
   Numerous studies have demonstrated acupuncture stimulation and induced enhancement of various types of neurotransmitter activities in the central nervous system.2,3,5,8,13,19,20 b-Endorphin activity in the peri-aqueduct increases by 2 to 21/2 times the baseline level; the duration can be up to several hours at times. Other neurotransmitter activities, including serotonin and norepinephrine, have also been demonstrated. Findings indicate that norepinephrine may play some role in the management of acute pain, while serotonin appears to be more important in the control of chronic pain.
   To initiate the endogenous opioid activation effect, points LI 4 for surgical procedures above the clavicle, LI 11 for surgical procedures below the clavicle and above the diaphragm, and LR 3 for procedures on the lower extremities must be selected. These points can sometimes be used in combination to produce an enhanced effect.
   Studies reporting a failure to produce this endogenous opioid activation effect have been shown. However, in reviewing those studies, it appears that the endorphin-related points as described above were not used. In other cases, the points have been stimulated at too high a frequency. According to Stux and Pomeranz,2 the opioid-related stimulation was mediated through the low-frequency stimulation of A-beta fibers. Therefore, the actual needling and the application of electro stimulation should not produce a sharp pain. This stimulation should be applied approximately 20 to 30 minutes immediately prior to surgery to produce the desired level of effectiveness. It has also been suggested that a similar acupuncture application within 24 hours prior to surgery, and then again within 20 minutes prior to surgery, may produce an enhanced effect.
The Nervous System

   The application of acupuncture in the proper combinations can induce a series of changes along the ascending pain pathway and the descending inhibitory system.1,2,9,14-16,21 In this manner, the most significant areas affected seem to involve spinal cord interneuron activation. The activation of these neurons prevents the "wind up" mechanism of intensified pain. Also, the acupuncture activation of Raphe Magnum Nucleus and stimulation of the hypothalamus seem to attenuate acute pain perception.
   Interruption of peripheral nerve (a-delta conduction) is perhaps not a true acupuncture effect. There are several devices available that are able to completely block out the pain from incision. They involve the use of electrical stimulation at a high frequency (200-300 Hz) at the incision site or along the major nerve trunk innervating the incision site. Other alternatives include an electrical stimulator connected to needles along the nerve trunk, or 2 long electrodes that are placed either transcutaneously or percutaneously along both sides of the incision. This type of high-frequency stimulation (>400 Hz) can produce analgesia in less than 5 minutes.
Point Selection
  • LI 4
    Contralateral or bilateral, used for surgeries above the clavicle, and sometimes used in chest surgeries (Chinese). Initiates uterine contraction; contraindicated in pregnancy unless the induction of labor is desired.
    Indications: Relieves pain in the head and otolaryngological conditions, fever, URI, trismus, and urticaria; induces uterine contraction.
  • MH 6
    "Luo Point" of Principle Meridian, "Master Point" of Yin Wei Mo, and "coupled point" of Chong Mo.
    Indications: Mental symptoms of excess Fire, cardiac arrhythmia and angina pectoris, nausea and vomiting, hiccups, and gastrointestinal "fire."
  • TH 6
    Zhigon is the "branch ditch," Fire point, and Luo point.
    Indications: Shoulder and arm pain, chest wall pain, post-thoracotomy, intercostal neuralgia, sore throat, and constipation.
  • TH 5
    Waiguan is the "outer gate," Luo Point, Master Point of Yang Wei, and coupled point of Dai Mo.
    Indications: High fever, chest and neck inflammatory conditions, tinnitus, migraines, enuresis, central nervous system diseases, and upper extremity joint pain.
  • LR 3
    Ta Chong is the "great pouring," Shu/Wood point, and source point.
    Indications: Headaches, vertigo, hypertension, insomnia, hepatitis, mastitis, thrombocytopenia, irregular menstruation, chest wall pain, and urinary retention.
  • ST 36
    Zusanli is "three measures on the leg," he/earth point, and special command point for stomach (strengthening).
    Indications: Gastroenteritis, pancreatitis, digestive disorder, shock, weakness, fatigue, allergies, constipation or diarrhea, lower abdominal distention, breast diseases, and nausea/vomiting.
  • SP 6
    Sanyingjiao is "three yin junction."
    Indications: Abdominal distention, borborygmus, diarrhea, gynecological disorders, urinary retention and incontinence, sexual dysfunction, eczema, and urticaria.
Ear Points (Pain Control-Related)3,29
  • Master Point 1
    Shen Men. Divine Gate. Wonder point.
  • Master Point 2
    Sympathetic.
  • Master Point 3
    Thalamus. Subcortical. Pain control point.
  • Master Point 7
    Tranquilizer point. Relaxation point.
  • Anatomical corresponding points.
  • Lung Point: Skin incision.
KHT (Hand Points)12
  • Corresponding points.
  • Basic prescriptions. Upper Heater/Jiao. Middle Heater/Jiao. Lower Heater/Jiao.
  • Shu Mu points for internal organ surgeries.
Basic Principles Of Electrical Stimulation To Acupoints (Intra-operative And Immediately Pre-Operative)1,2,6,8,9,14,20,22
  • Meridian (Body) Points
    Low frequency direct current 2-4 Hz.
    Ipsilateral or bilateral.
    LI 4 or 11; contralateral.
    Moderate output, starting 20 minutes pre-operatively.
  • Auricular Points
    Low frequency 2-4 Hz, may induce electro-coagulation in 15 minutes, and difficulty in removing the needle. Also may attenuate effects with time.
    Starting at 5 minutes pre-operatively.
  • Local Point/Area Stimulation Adjacent To Surgical Site
    High frequency 400-1000 Hz.
    Graded increase in output intensity according to adaptation.
    10-15 minutes immediately pre-incision, and removal immediately prior to incision/scrubbing.
  • KHT12
    E-beam stimulation after incision to supplement pain control and symptomatic treatments.
General Introduction to Point Combinations for
Surgical Analgesia/Avoidance of Contamination to
Surgical Site)
6,8,13,14,18,21,23-25
  • Skin Incision
    LI 4, LI 11.
    Auricular Therapy: Lung point, Shen Men.
    20-30 minutes of electrical stimulation at 2-4 Hz.
  • Oral, Facial
    LI 4, ST 44, MH 6.
    Auricular Therapy: Tranquilizer, Thalamus, and corresponding points.
  • Chest Wall Procedures
    LI 11, TH 5 or 6, ST 41 or 44.
    Auricular Therapy: Tranquilizer, Thalamus, corresponding points.
  • Intrathoracic Procedures
    LI 11, TH 6, MH 6, CV 17, GV 14.
    Auricular Therapy: Sympathetic, Heart, Lung.
  • Upper Abdominal Procedures
    LI 11, ST 36, SP 6, MH 6.
    Auricular Therapy: Sympathetic, Stomach, Heart, corresponding points.
  • Pelvic Procedures
    LI 11, ST 36, SP 10, MH 6, Dai Mo.
    Auricular Therapy: Pelvis, Sympathetic, corresponding points.
  • Genital-Rectal Procedures
    LU 6, SI 7, SP 6, LR 1, KI 6.
    Auricular Therapy: Sympathetic, Heart, Shen Men.
  • Upper Extremities
    LI 4, TH 5, MH 6, GB 21, and GB 34.
    Auricular Therapy: KI, LU, SP, corresponding points.
  • Lower Extremities
    LI 11, ST 36, GB 34, KI 3, LR 3.
    Auricular Therapy: KI, LU, SP
  • Obstetrical
    • Hyperemesis gravida26
      MH 6, ST 36, 40, LR 3.
      Auricular Therapy: LR, ST Sympathetic (Shen Men).
      KHT: KA 8, 12, 16, 18, KK 9, KF 5
    • Conversion of breech position of fetus
      - Moxibustion BL 67
      - KHT: KA 1, 3, 5, 6, 8, KI 19, KT 23, KF 5
    • Induction of labor (or abortion)
      - LI 4, SP 6
    • Labor (not as effective and convenient as epidural anesthesia)27
      - BI 23, 26, 30, 33, SP 6, LI 4, MH 6, Chong Mo, Dai
  • Other Systems Used Intra-Operatively:
    Nasal, facial, scalp, and "Barefoot Doctor's Anesthesia Points."
   In the intra-operative application of acupuncture, body point needles should be removed if they interfere with the surgical site (likewise, auricular points in facial surgeries). Electrical stimulation is to be used only at points accessible to the anesthesiologist. Additional points may be added through microsystems (e.g., hand, scalp, and auricular points). The number of needles should be kept to a minimum. Continuous electrical stimulation (especially at a high frequency and/or long duration) should be avoided.
POST-OPERATIVE PREPARATION
WITH ACUPUNCTURE

   Acupuncture may be used to enhance and supplement symptomatic medical treatments and to restore physiological functions.1,2,6-8,10-12,22,28 It is not necessary to use acupuncture to completely supplant the use of medications. However, the supplementary use of post-operative acupuncture can decrease the amount of opioids and/or other symptomatic control medications needed to relieve post-operative pain, thus facilitating early ambulation, fluid and food intake, and hospital discharge. Moreover, in situations in which medications are not applicable or effective, acupuncture can be helpful.

  • Acute Pain Management
    Basic principles are the same as intra-operative point combinations, but points closer to the surgical site can be used with proper aseptic techniques.
    KHT (hand acupuncture) system.
    Curious Meridians (very effective in acute conditions).
  • Nausea/Vomiting Control29
    MH 6, ST 36, LR 3.
    Auricular Therapy: Sympathetic, Stomach.
    KHT: KA 8, 12.
  • Post-Extubation Spasm of the Larynx
    MH 6, KI 3.
    Auricular Therapy: Lung points.
    KHT: KE 8, KA 20, 24, KM 5.
  • Urinary Retention
    Deep-drainage K-UB (Distinct Meridian).
    SP 9, LR 8.
    Chong Mo.
    Auricular Therapy: Sympathetic corresponding points.
  • Paralytic Ileus
    LI 11, ST 25, 36, SP 4.
    Auricular Therapy: LI, SI (constipation points).
    KHT: KI 19, KE 22.
  • Hiccups
    MH 6.
    Auricular Therapy: Diaphragm. Stomach. Tranquilizer.
    KHT: KK 9, KB 20, KM 10.
CONCLUSION
   The use of acupuncture to complement medications has many advantages in pre-operative preparation of patients with co-existing diseases. This is especially evident in patients with chronic cardiopulmonary diseases. Pre-operatively, acupuncture treatments can alleviate chronic symptoms and enhance responses to medications within a short period. This effect frequently carries through the intra-operative and post-operative periods to facilitate recovery and early hospital discharge.
   During the immediate pre-operative period, application of acupuncture should be simplified: no more than 1 to 4 body points and/or up to 4 auricular points are used; the duration of stimulation is reduced to 20 minutes.
   Intra-operatively, acupuncture-assisted anesthesia is recommended to bypass the disadvantages of incomplete blockage of pain by the use of acupuncture alone. Moreover, acupuncture enhances the results of regional and local anesthesia, and allows for a reduction in the dose of intravenous opioids and sedatives or the total dose of general anesthetics needed. Further titration and definition of the impact of acupuncture to general anesthesia can be assessed with the aid of moderate anesthesia depth-monitoring devices currently available.
   Post-operatively, the treatment of symptoms can be achieved effectively with proper use of acupuncture in conjunction with medications. The supplementary use of post-operative acupuncture can decrease the need for opioid and/or other symptomatic control medications and thus facilitate early ambulation, fluid and food intake, and discharge.
   The physician should have a thorough understanding of acupuncture theory and point combinations required to achieve the desired effects. According to Eastern philosophy, the role of acupuncture is not to create a super being, but rather to bring the internal universe (body physiology) to a neutral, harmonious, and balanced state. Acupuncture is to be used to help the body adapt to the external universe, and to synchronize with the movements of the Five Elements to survive and maintain health. Without proper pulse, tongue, abdominal diagnoses, and individualized prescription treatment, formulated "cookbook" approaches will yield less than satisfactory results.
   Finally, the practice of acupuncture described herein is, in many ways, contrary to the philosophy of bringing the body to neutral. Peri-operative acupuncture attempts to achieve an abnormal state of sedation, insensitivity to pain, and reduced awareness and concern. This noble purpose is to be carefully pursued, always bearing in mind the physician's oath, "First, Do No Harm."

REFERENCES
1. Helms JM. Acupuncture Energetics: A Clinical Approach for Physicians. Berkeley, Calif: Medical Acupuncture Publishers; 1994.
2. Stux G, Pomeranz B. Basics of Acupuncture. 3rd ed. New York, NY: Springer-Verlag New York; 1995.
3. Tempfer C, Zeisler H, Heinzl H, et al. Influence of acupuncture on maternal serum levels of interleukin-8, prostaglandin F2a, and beta-endorphin: a matched pair study. Obstet Gynecol. 1998;92:245-248.
4. Abbate D, Santamaria A, Brambilla A, Panerai AE, Di Guilio AM. Beta-endorphin and electroacupuncture. Lancet. 1980;2:1309.
5. Clement-Jones V, McLoughlin L, Tomlin S, Besser GM, Rees LH, Wen HL. Increased beta-endorphin but not met-enkephalin levels in human cerebrospinal fluid after acupuncture for recurrent pain. Lancet. 1980; 2:946-949.
6. Hseuh CC. Acupuncture: A Comprehensive Text. Seattle, Wash: Eastland Press; 1981.
7. Academy of Traditional Chinese Medicine. Chinese Acupuncture and Moxibustion. Rev ed. Beijing, China: Foreign Language Press; 1999.
8. Mok YP. Acupuncture, analgesia, and anesthasia. Medical Acupuncture. 1996;8(1):
9. Chan P. Electro-Acupuncture: Its Clinical Application in Therapy. Los Angeles, Calif: Lau's Co; 1982.
10. UCLA Research on Auricular Acupuncture. Los Angeles, Calif: UCLA Pain Management Center.
11. Oleson TD. Auriculotherapy Manual: Chinese & Western Systems of Ear Acupuncture. Los Angeles, Calif: Health Care Alternatives; 1996.
12. Yoo T-W. Koryo Hand Acupuncture. 2nd ed. Korea: Eam Yang Mek Kin Publishing Co. In press.
13. Mok YP. Medical acupuncture applications in surgical anesthesia. AAMA Review. 1993;1:20-24.
14. Yang M. Principles and Clinical Application of Acupuncture Anesthesia. Hong Kong, China: Era Book Co; 1986.
15. Academy of Traditional Chinese Medicine. Acupuncture Research. Vol 10. Beijing, China: Foreign Language Press; 1985.
16. Fang XH. Regional anesthesia for microsurgery in China: a review. Reg Anesth. 1989;14:55-57.
17. Herget HF, L'Allemand H, Kalweit K, et al. Combined acupuncture analgesia and controlled respiration: a new modified method of anesthesia in open heart surgery [in German]. Anaesthesist. 1976;25:223-230.
18. Liu WC. Acupuncture anesthesia: a case report. JAMA. 1972;221:87-88.
19. Han JS, Tang J, Ren MF, Zhou ZF, Fan SG, Qiu XC. Central neurotransmitters and acupuncture analgesia. Am J Chin Med. 1980;8:333-348.
20. Malizia E, Andreucci G, Paolucci D, Crescenzi F, Fabbri A, Fraioli F. Electroacupuncture and peripheral beta-endorphin and ACTH levels. Lancet. 1979;2:535-536.
21. Acupuncture Anesthesia Writing Group. Introduction to Acupuncture Anesthesia Apparatuses. Shanghai, China: Acupuncture Anesthesia People's Publishing House; 1972.
22. Wang B, Tang J, White PF, et al. Effect of the intensity of transcutaneous acupoint electrical stimulation on the postoperative analgesic requirement. Anesth Analg. 1997;85:406-413.
23. Wang K, Wang S, Li Z. A clinical observation for the posterior atlanto-axial arthrodesis under acupuncture anesthesia [in Chinese]. Chen Tzu Yen Chiu. 1996;21:8-10.
24. Jiang C. Normalization of acupuncture anesthesia used in operation of neoplasm in functional area or deep site of brain [in Chinese]. Chen Tzu Yen Chiu. 1996;21:4-7.
25. Zhang S, Tang Z, Wu Z, Li L, Zhang R. Research of clinic and laboratory of face acupuncture effect and the exploration of their afferent pathways [in Chinese]. Chen Tzu Yen Chiu. 1996;21:39-44.
26. Belluomini J, Litt RC, Lee KA, Katz M. Acupressure for nausea and vomiting of pregnancy: a randomized, blinded study. Obstet Gynecol. 1994;84:245-248.
27. Tsuei JJ, Lai Y, Sharma SD. The influence of acupuncture stimulation during pregnancy: the induction and inhibition of labor. Obstet Gynecol. 1977;50:479-480.
28. Ho RT, Jawan B, Fung ST, Cheung HK, Lee JH. Electro-acupuncture and postoperative emesis. Anaesthesia. 1990;45:327-329.
29. Dundee JW, Sourial FB, Ghaly RG, Bell PF. P6 acupressure reduces morning sickness. J R Soc Med. 1988;81:456-457.
30. Brown SD. Introduction to Meridian Therapy. Seattle, Wash: Eastland Press; 1995.