Sunday, May 22, 2011

Acupuncture Treatment of Chest Tightness and Palpitations

Chief Complaint: Chest tightness and palpitations chronic for eight years with an acute presentation for 2 weeks.
Medical History: The patient has been tested by a medical doctor for heart problems. The tests including an EKG, Stress Test, and blood values of cardiac enzymes show that the patient is within normal range. Her symptoms generally include tightness in the chest that is always present and palpitations while resting that can last as long as 20 minutes. On several occasions she experienced pain radiating down her left arm. The problem began 8 years ago after her fiance died. Prior to this incident she did not experience any of the signs and symptoms described above.
Questioning exam: Today the patient returned to the clinic after a month long break from treatment complaining of slight chest tightness and palpitations that come in the evening as she is relaxing or trying to go to sleep. Her appetite is good and she eats 3 meals per day consisting of the 4 food groups. The patient reports that her digestion is good meaning that she does not experience gas, bloating, stomach pain or acid regurgitation after eating. She has one bowel movement per day that is well formed and complete. She drinks 8 to 10 glasses of room temperature water per day. She enjoys a cup of coffee in the morning and tea or a carbonated soft drink in the afternoon. She urinates 4 to six times per day and the volume of urine relates to her intake of fluids. She reports that her body temperature is normal but she tends to dress warmly. She sweats with exertion during day and wakes once during the night feeling clammy and overheated Her energy is usually 7 to 8 our of 10 but today she reports feeling sluggish. She falls asleep easily and wakes 1x due to sensation of heat and dampness whereupon she falls back to sleep and wakes rested. She reports having vivid dreams that are not stressful. She typically can’t remember her dreams. The patient’s emotional state is good as she exhibits a positive attitude toward life. Her HEENT are mostly clear with a slight cigarette smokers cough. The patient’s menstrual cycle is pending any day. She experienced menarche at 13 years old. The interval of the cycle is typically 28 to 30 days with a duration of 4-5 days. The volume of blood is moderate and its color is red blood ending with a rusty red and is without clots. PMS symptoms include distended sensitive breasts, emotional upset, increased fatigue, and dull pain in the lower abdomen. She has skipped a cycle recently and notices that the interval seems to be getting longer in general. The flow has been erratic in the last 6 months changing from heavy to spotting in unpredictable patterns. She attributes the changes to the first signs of menopause.
Pulse exam: The pulse was felt on the middle and deep levels on both wrists. The right side was dominant. Both hands had a thin pulse felt in the middle level at the cun and guan position. The strength of the pulse increased at the deep level where the chi position could be felt. The rate was 92BPM with a regular rhythm.
Tongue exam: The tongue body is puffy top to bottom especially in the center. There is a deep crack from the Kidney area to the Stomach/Spleen region with a thin crack to the tip. The color is slightly red with a very red tip. The coating is thick and slightly yellow due to cigarette smoking. There are scallops on the sides. The sublingual veins are not distended. The patient is 5’6″ and 120#. She actively participates in the consultation. Her movements are fluid and graceful. There are no unusual odors.
OM Diagnosis: The diagnosis is Qi stagnation in the Heart channel due to emotional trauma. This Qi stagnation has created heat in the upper jiao and has blocked the cooling mist of kidney yin from reaching the heart.
Treatment Principle: Open the chest and cool the heart.
Point Prescription: Yin Tang pacifies wind and calms the shen – insomnia, agitation, restlessness
Ren 17 front Mu of pericardium, influential point of Qi regulates Qi and unbinds the chest
H 7 the source point for the heart and the shu stream point – cardiac pain, palpitation
Lu 9 source point for the lung and the shu stream point and the influential point of vessels palpitation and pain in the chest
P 6 the Luo point of the pericardium – cardiac pain, palpitation, stuffy chest,
K 7 Jing river point night sweating
Liv 3 the source point for the liver and the shu stream point – emotional upset, depression
Herbal Formula: herbs were not recommended.
Lifestyle Prescription: craniosacral therapy, aromatherapy and massage
Results: patient felt immediately better after her first treatment and was treated twice a week. after 1 month/8 treatments the palpitations were resolved to a few quick beats after getting into bed to go to sleep.
Synopsis: using he gu ci fa techninque on Ren 17 and combining this point with LI 4 and Lu 7 seemed to have the greatest effect on the chest tightness and i have found it very effective in treating asthma.

Acupuncture and Herbs for Excessive Menstrual Flow

Chief Complaint: 1- Excessive menstrual flow
Western Diagnosis: The patient was diagnosed with fibroids by a M.D
Medical History: Female, 46 years old
Secondary complaint, recurrent sinus infections
Questioning exam: 1-Her symptoms consist of a lack of a menses for 2-3 months, followed by a heavy flow for 2-3 weeks. The flow is dark and has clots. She feels her abdomen is tight while menstruating, and finds that moving and stretching relieves it.
2- The patient has gotten a sinus infection every six months for as long as she can remember. The discharge from her nose starts clear, but becomes green and bloody.
Pulse exam:
Pulse: Rapid, slippery
Tongue exam: Tongue: Scalloped, white coat, lavender color
OM Diagnosis: 1- Uterine bleeding due to blood stasis (beng luo)
2- Local obstruction of Yang Ming channel
Treatment Principle: 1- Move blood stasis
2- Clear obstruction, move qi
Point Prescription: Sp1, Sp10, Sp8, Sp6, Yin Tang, Du 20, LI4, St36, Du23, LI20->BiTong, St3
Herbal Formula: Ge Xia Zhu Yu Tang
Results: Menstrual flow decreased after treatment, and stopped a day or so after treatment.

The Treatment of Anxiety with Acupuncture

Chief Complaint: spontaneous sweating, nervousness
Western Diagnosis: anxiety
Medical History: recent weight loss of 150 lbs, recent dramatic change in lifestyle from unhealthy, greasy, sweet and alcohol diet to a healthy one (hence the weight loss) many traumatic life events; deaths of close loved ones, divorce.
Questioning exam: unstable emotions
mental restlessness worse at night
low energy
sweating on palms and legs, worse with anxiety
lots of dreams
persistent low grade nausea
occasionally morning bowel movement triggers vomiting and abdominal cramps
constant back pain, tightness; better with movement
Pulse exam: skin very damp
clear sweat
pulse sunken and weak in especially in the lung area, unsmooth
Tongue exam: light purple, pale body color, thick, greasy, yellowish coating
OM Diagnosis: lung and stomach qi deficiency, phlegm heat, qi stagnation
Treatment Principle: remove obstructions, disperse fluids regulate stomach qi, tonify qi, calm spirit
Point Prescription: 1st treatment: aggressive energy
2nd treatment: internal dragons
3rd treatment: st36, lu7, pc6, kd9, kd26, kd7, li4, ht6 all contralateral except kd26, lu7
Herbal Formula: gan mai da zao tang with wen dan tang
Lifestyle Prescription: replacement of coffee with herbal tea
Results: back pain gone for several days after AE, felt a tangible weight lifted off….
2nd treatment not as noticeable effect but felt calmer the whole week
3rd treatment felt very electrical… went home and cried for aver an hour
Synopsis: continuation of moving qi, disperse fluids, dissolve phlegm…. tonify lung qi

Acupuncture Treatment of Acne Rosacea

Chief Complaint: Acne Rosacea
Medical History: The patient is a 50 year old female whose Acne Rosacea, localized mainly around her mouth and chin. During her adolescent years she was diagnosis with severe Acne by her physician. In her thirties she was diagnosis with Acne Rosacea by a Dermatologist. For past two years the outbreaks has been moderate to acute. Her lesion is diameter of an eraser on a pencil. They are pustules and painful. When the lesion breaks open, they bleed and is easily irritate. Simply splashing water on her face to wash it or wiping her mouth area with dinner napkin can cause the to lesions to bleed.
The patient has consulted a Dermatologist and was prescribed topical metronidizaloe cream, applied twice a day as treatment, which made no difference. Erythromycin was also prescribed and worked to some extent, but only as long as she was taking them.
Questioning exam: Patient likes eating spicy foods; has flush cheeks and chin; hass occasional night sweats (d/t menopause); bowel movements re loose, 2-3xday sometimes more and sometimes they are explosive and urgent; thirst – constantly consume water all day long because she弤 a History teacher and talks all day.
Other symptoms included mild dizzy spells for the past year, generalized headaches with no specific location a few times a week, stiffness in the trapezius, trouble falling asleep, and general stress. She is slightly irritable, especially before her menses, color red to darker red with some clots lasting for 5 days. The patient runs on the cold side.
Pulse exam: Pulse: wiry, slippery, rapid
Lesions feel hot and tender to the touch. Lesions mainly around mouth and chin. Redness in central areas of the face, forehead and chin.
Tongue exam: Red tip, thin to moderate white coat with yellow line in down the center of the tongue
OM Diagnosis: Diagnosis:
1. Heat toxin (acute)
2. Heat in Lungs and Stomach (chronic)
Overindulgence of alcohol or spicy foods, causing excessive heat in the Stomach and then steams the Lung.
Pre-existing accumulated Lung and Stomach heat combining with attack by heat toxin.
Disharmonies of the penetrating and conception channels, causing blood heat stagnation in the skin and tissues of the nose area, giving rise to the lesions.
Point Prescription: The patient did not want her face needled.
Ears Points: External Nose, Endocrine, Lungs, Shen Men and Adrenal.
Body points: LI 11, SJ 5, ST 44, LI 4 & LR 3, LU 3, ST 36
Needle retention was 15- 20 minutes.
When her diarrhea was severe (explosive), salt moxa on RN-8
Herbal Formula: Patient did not want herbs
Lifestyle Prescription: Decrease /stop consumption of alcohol, spicy foods and fried greasy foods
Results: After the first treatment the lesions dried up significantly, but lesions returned approximately a week later. After approximately 3 months of treatments twice a week, the lesions cleared up completely and reappeared occasionally. From month 4 to current, she has been receiving weekly or bi-weekly treatments and Acne Rosacea has not flared up.

Chinese Medicine Treatment of Brain Damage

Chief Complaint: Spasticity, inability to eat, speak, control movements
Western Diagnosis: Brain Damage caused by Anoxia during surgery
Medical History: Patient “D” was twelve-year old boy undergoing hernia surgery. Anesthesiologist forgot to set blood pressure cuff and D had ten minutes when his brain had no oxygen. His muscles seized, could not breathe on his own, was fed through tube, could not walk, speak or toilet himself. D could only “blow raspberries” at his mother to show disapproval but could not blink his eyes voluntarily.
Questioning exam: Because patient could not communicate directly, I am listing signs. Functional symptomatology listed above in relevant medical history. Patient was pale, muscles on arms and legs were contracted and spastic. He had appearance of “puppet” — almost like “wooden” boy. He had been a piano prodigy and a skilled soccer player before the surgery, however when I saw him for the first time (four months after the “accident”, he could not stand, his feet and fingers were contracted. However, when I played Mozart for him during treatments, his eyes lit up and he began vocalizing “ah, ah, ah” during pieces that he had played before the accident — when he still had use of his fine motor muscles. D’s skin and nails were very dry. His eyes were quite dry (however he was unable to close them voluntarily). D did wear “drypers” and had to be bathed by his nurses and fed liquid meals through his feeding tube. He could not control his urine or bowel evacuation. He was cold all the time and needed to be covered in blankets. He was not growing or developing.
Pulse exam: Pulse was overall very deep and weak. When palpable it disappeared with pressure.
Tongue exam: Tongue was deviated but flabby and pale.
OM Diagnosis: Sudden anoxia caused muscles and whole body not to be nourished. Severe blood deficiency causing wind in the channels. Because of injury to brain, kidney channel damaged — patient showing signs and symptoms of kidney yang xu — cannot control toileting, experiences cold, not developing.
Treatment Principle: Nourish blood and yin, clear wind.
Nourish kidney channel – yin and yang.
Point Prescription: St 36 GB 34 GB 39 Liver 2 Liver 3
Spleen 10 Spleen 6, LI 4, LI 11, Ear shenmen, Kidney 3, Kidney 7, Kidney 9. Moxa used on St 36, Ren 4, 6, 8 and Kidney points. Patient could not lie on his stomach until several months into treatment, at which point I added UB23, UB17, UB18, UB15 and SI points around the shoulder to relax rhomboids. These points were not all used concurrently, but varied over the course of treatment.
Herbal Formula: Began with raw herb formula-his mother would pour it down feeding tube.
Liu Wei Di Huang Wan Jia Wei
(added Gou Qi Zi, Che Qian Zi,
Rou Gui, Fu Zi, Dang Gui, Loranthi,
Bai Shao, etc.
This formula was augmented as he began to “come back to life”. I teased him and called him “pinocchio”. He was like the wooden boy who softened and whose movements became more fluid. After six weeks of these herbs and two acupuncture treatments per week, his large family had a big party and took him to JC Penny to buy undershorts because he could finally control his urination and bowel movements. Within a few months he could blow kisses at his mother, articulate words, yell at me (liver qi stagnation emerged as he strengthened, but then again he had finally entered puberty and was an adolescent in all ways, including his demeanor.)(D did grow, develop, voice deepened, etc.).
Lifestyle Prescription: D was receiving speech and occupational therapy at the hospital twice weekly. When I learned he loved marine life we searched for dolphin therapy on the internet and found a site in Southern Florida where he ended up going quarterly with his family. His parents felt that he made huge developmental strides from his time in the water with the animals.
Results: As written above, D was helped in a big way by Traditional Chinese Medicine. When he began to feed himself and the feeding tube was removed, his improvement slowed to a “not-so-dramatic” pace — because he fought taking the herbs which had helped him so significantly — and had also become a “moody” teenager.
Synopsis: When I last saw D, he was walking, talking (not totally clearly, but we could understand his words). He was attending school for a half day with his nurse as his shadow. He could shower himself, take himself to the bathroom, spend time laughing with his friends, and was securing a voice-prompt computer system so he could be on email to his friends and family. He could walk by himself and even on stairs — but at the time I saw him last, he was still experiencing spasticity in his forearms and fingers and could not perform fine motor skills. He doctors were mediating this a small amount with quarterly botox injections into the joints, but without significant success. It is so interesting that when D’s brain began to function again, it was as though he were an infant going through early stages of development — his function returned in the same “order” as if he were developing for the first time.
D no longer lives in the same city as I but touched my life significantly. I learned so much in treating and in knowing him. He is very brave young man.