I gave a presentation to The Retired Men Association of Greenwich on Wednesday, Feb. 24, 2010. My topic was Acupuncture and Pain Management for lower back pain. Tomorrow, Monday, March 1st, I will be featured on GCTV Channel 79 at 1:00 p.m. and 5.00 p.m. If you are interested, please check the following schedule and I will appear regularly throughout this week.

Thank you very much for your support.

Best,

Jun Xu, M.D.

Jun Xu
Please see my home page at www.drxuacupuncture.com and www.rmac.yourmd.com
You may see my photo blog at www.drxuacupuncture.com
Office Phone:203-637-7720

Schedule for the Week of February 28, 2010

February 14 was the first day of the Chinese New Year. This year is the year of the tiger. In Chinese tradition, the year of the tiger will usually make you look forward to the bright future and bring you an exciting fortune. Therefore, we wish you a Happy Chinese New Year of Tiger!

This month’s case discussion is about Trigeminal Neuralgia, which is common to middle and elderly aged people. We hope you may learn something from this case discussion.

Happy Chinese New Year!!!

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

News Letter, Vol. 2 (2), February, 2010, © Copyright

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

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

Rehabilitation Medicine and Acupuncture Center

1171 East Putnam Avenue, Building 1, 2^nd Floor

Greenwich, CT 06878

Tel: (203) 637-7720

TRIGEMINAL NEURALGIA

Sharon, a 65-year-old woman who suffered from a toothache on the right side of her mouth for a month, finally consulted her dentist who found two loose teeth in the back, right side of the mouth.  The patient loves sweets, which may have caused the problem, but the pain was so severe that she was unable to sleep.  The pain occurred proximally and started when Sharon tried to brush his teeth; the pain was so severe that she could not bear to touch the teeth or the right side of her face and jaw.  Even air currents could trigger the pain.  She had difficulty eating, talking, and brushing her teeth.  The shooting pain felt like electrical shocks and burning, and, at times, was unbearable.   It attacked the right side of the jaw and face and lasted for hours.  The patient intentionally tried not to use the right side of  teeth in order to avoid triggering an episode of pain.   Finally, the dentist decided to pull out the two lower teeth.  At this point, the patient felt immediate swelling on the right side of her face and, after a week, the pain became worse.  The doctor also prescribed narcotics to ease the pain. There was no improvement after the tooth extraction and the patient still could not touch the right side of his face.

Upon examining him, I discovered that although the pain did not extend to the right side of her eye, the right cheek and jaw were tender and the pain was described as intolerable by the patient.  She felt it was incapacitating her to the extent that she was losing normal function and had dropped ten pounds.  She also experienced fatigue and was unable to sleep.

Sharon is suffering from trigeminal neuralgia.  The trigeminal nerve carries sensation from the face to the brain.  Many studies indicate that when the superior cerebellar artery compresses this nerve, the nerves protecting the myelin sheath are injured, causing erratic and hyperactive function of the nerve.  This can lead to pain at the slightest stimulation of any area served by the nerve, as well hindering of the nerve’s ability to shut down pain signals when the stimulation ends.  The trigeminal nerve is the fifth cranial nerve, which registers sensory data such as pressure and temperature and measures pain originating from the face above the jaw line.  The trigeminal nerve has three branches, one going to the eye, the second to the mouth, and the third to the jaw.  In Sharon’s case, two of these three trigeminal branches (mouth and jaw) were affected. This condition is usually found in males and females at the ratio of 2:3, and most trigeminal neuralgia cases are idiopathic and typically occur in the sixth decade of life, although they may occur at any age.  The symptomatic or secondary trigeminal neuralgia may occur in younger patients.

The patient’s history is the most important factor in the diagnosis of trigeminal nerve neuralgia.   The nature of the pain may be brief and proximal, but it may also occur in multiple attacks and may be stabbing or shock-like or extremely severe.  It is usually distributed in one or more branches of the trigeminal nerve and is usually maxillary or mandibular and unilateral.  This pain typically lasts from a few seconds to one to two minutes and will typically occur for a few months each year.

Treatment with Western Medicine:

1. Medications. The most typical medications prescribed by doctors and dentists are anticonvulsants such as carbamazepine, oxcababazepine, phyntoin or gabapentin.  Generally, these are the most effective for pain relief, and can be adjuncted with muscle relaxants such as baclofen.  Some opiates can also be effective such as OxyContin or Duragesic in patch form, for decreasing pain in the jaw and face, as well as low doses of antidepressants such as amitriptyline.
2. Surgery. Surgery may relieve pressure on the nerve or selectively truncate the nerve by disrupting the pain signals from getting through to the brain. It is usually 90% successful if done by an experienced surgeon.  The most specific kind of surgery is microvascular decompression.
3. Stereotactic radiation therapy. A surgeon uses a gamma knife or linear accelerator (a form of radiation therapy) such as the Novalis Cyberknife.  The therapy penetrates the skin and targets the selective nerve root and disrupts the pain signal transmissions.

Treatment with Traditional Chinese Medicine:

According to Traditional Chinese Medicine, the stomach meridian is distributed around the eye, the jaw, and the teeth.  Therefore, if the stomach meridian is blocked, the external wind and heat will be mutually mixed, and the wind flame will invade the stomach meridian and cause severe pain along the meridian (i.e. along the face, teeth, and eye).

The main treatment for trigeminal neuralgia is to soothe the stomach meridian by redistributing the wind, dissipating the heat and improving the energy flow in the area. The acupuncture points along the face, eye, and teeth must be carefully selected.  The three branches of the meridian should be treated separately:

1.       Ophthalmic nerve branch. This is the top branch of the trigeminal nerve.  Acupuncture points include the EX-HN4 Yu Yao, GB 1 Tong Zi Liao, SJ 23 Si Zu Kong, EX-HN5 Tai Yang and UB1 Jing Ming.  The needles should be inserted in 0.3 to 0.5 inches deep.  The patient should feel a stimulation similar to an electric shock. Continue to twist the needles three to five times, and then put the needles on the electrical stimulating machine for 30 minutes.

2.       Maxillary nerve branch. Use the St 2 Si Bai and St 1 Chen Qi points and the manipulation described above.

3.       Mandibular nerve branch. Use the St 7 Xia Guan, Ren24 Cheng Jiang and St 4 Di Chang points and the manipulation described above.

In addition, choose some body points such as GB40 Qiu Xu, Li v 5 Li Gou, LI 4 He Gu, Lu 7 Lie Que, etc. in order to adjust the energy of the entire body.

Stimulating these above acupuncture points can improve the energy flow and decrease the pain sensation signals that the trigeminal nerve sends to the brain.  The acupuncturist must ensure that the patient feels an electrical shock sensation from the needles.  This treatment allows the energy to go to the trigeminal nerve to improve the energy flow and decrease the pain.

Sharon was treated with a combination of Treatments # 2 and # 3 plus electrical stimulation of the acupuncture needles three times a week for three weeks.  After the first visit, she felt better and reported getting a good night’s sleep for the first time in six weeks.  After four weeks of treatment, the pain had subsided by 80%; thus, the treatments were decreased to once a month; after six months on this schedule, the patient told me he felt no more pain.

In my experience, the treatment of this illness has two facets.  First, there must be a clear diagnosis.  In Sharon’s case, the dentist was wrong in the evaluation of the condition, and pulled two teeth unnecessarily. It is also necessary to combine western medicine with TCM in this case, and to treat all three of the nerve branches, if necessary.  If the treatment is done properly, the patient’s pain should subside and he/she should be able to function normally in day-to-day life.

Tips for acupuncturists:

1. You should combine the local points with the distal points for your treatment.
2. Electrical stimulation is very important.
3. Do not use moza in these kinds of cases.

Tips for patients:

1. Seek for medical attention as early as possible.
2. An ice-cold massage at the above points might decrease the pain.

Happy New Year!

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

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

Best,

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

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

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

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

Rehabilitation Medicine and Acupuncture Center

1171 East Putnam Avenue, Building 1, 2^nd Floor

Greenwich, CT 06878

Tel: (203) 637-7720

Case Discussion 13: Occipital Neuralgia

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

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

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

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

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

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

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

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

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

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

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

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

Tips for acupuncturists:

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

Tips for patients:

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

Happy Holidays!

Year 2009 will be ending soon. We wish everybody happy holidays and a prosperous 2010.

Please find the following news letter 12. We hope you will enjoy to read it.

Dr. Jun Xu recently started to take photos; one is attached here. We hope to hear your comments.

Happy Holidays and Happy New Year!

Best,

Jun Xu and Hong Su

News Letter, Vol. 1 (12), December, 2009, © Copyright

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

www.rmac.yourmd.com;

www.drxuacupuncture.com

Rehabilitation Medicine and Acupuncture Center

1171 East Putnam Avenue, Building 1, 2^nd Floor

Greenwich, CT 06878

Tel: (203) 637-7720

Cervical Dystonia

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

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

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

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

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

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

Tests and diagnosis:

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

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

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

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

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

Medications:

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

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

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

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

4. Carbamazepine is an anticonvulsant.

Botox injections:

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

Other treatments:

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

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

Chinese medicine:

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

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

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

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

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

The patient was treated with acupuncture at the above points for approximately two months, three times a week. After the last treatment, the number of neck contractions had significantly decreased. Now, she only experiences mild neck jerks and contractions, allowing her to perform her daily activities in a normal manner.

Tips for acupuncturists:

1. Acupuncture cannot treat all forms of cervical dystonia. The milder the disease, the better the treatment results.

2. Using heating pads and massages after the acupuncture treatment increases its
effectiveness.

Tips for patients:

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

2. Help yourself with massage and heating pad.

]]> http://drxuacupuncture.com/2009/12/24/case-discussion-12-cervical-dystonia/feed/ 0 drxuacupuncture xu_farm header_pic table_1 pic1-1-1-6 http://drxuacupuncture.com/2009/11/27/case-discussion-11-drug-abuse/ http://drxuacupuncture.com/2009/11/27/case-discussion-11-drug-abuse/#comments Fri, 27 Nov 2009 18:49:46 +0000 drxuacupuncture http://drxuacupuncture.com/?p=758 ]]> Dear Patients and Friends:

I assume that all of  you are having a wonderful holiday season. Please find the following News Letter 11. We will discuss about drug abuse. It might give you some idea to help others.

I wish you continue to have a wonderful holiday season.

Best,

Jun Xu, M.D., and Hong Su, CMD., L. Ac.

News Letter, Vol. 1 (11), November, 2009, © Copyright

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

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

Rehabilitation Medicine and Acupuncture Center

1171 East Putnam Avenue, Building 1, 2^nd Floor

Greenwich, CT 06878

Tel: (203) 637-7720

Drug Abuse

Peter W. is a 53 year old man who has been extremely successful in business. During his career, he built up a huge company which he sold for 20 million dollars in 2000.  Afterward, he felt depressed and realized he had nothing to do which made him sluggish and without motivation, as he had no goal to pursue.  He started using drugs, including heroin, which soon became a daily habit.  When he was no longer to procure drugs easily in the United States, he turned to the internet and started ordering drugs by E-mail, which were sent to him from Africa.  Though he had no real idea what he was using, he continued with his habit, which made him feel empty, depressed, anxious, restless and gave him insomnia, all of which caused a poor relationship with his wife and family.  On some occasions he used so heavily he was unable to rise from his bed for a couple of days, on other occasions his family had to rush him to the emergency room.  He felt occasional euphoria, followed by the deepest depression, and cloudy mental functioning.

He knew this was not way to live, so he tried to find work that would engross him.  For example, he took a charity job and helped the company build up cheap laptop computers for distribution to third world countries to help the young people there.  In spite of this worthwhile work, he still felt empty.  He took another job as V.P. and a seat on the Board of Directors in one of the biggest computer companies.  He worked very hard at this new job, however, as soon as he stopped working or had leisure time he found himself reverting to drug use.

Finally, he came to me for help, saying he wanted to quite drugs altogether.

Heroin is a highly addictive, illegal drug, the most abused and most rapidly acting of the opiods.  It is processed from morphine and naturally occurring substance extracted from the seeds of certain varieties of poppy plants.   It usually appears as white or brown powder, and sometimes is mixed with sugar and other substances to cut its strength.

Heroin has both long and short term effects.  The short term effects include: depression, bad respiration, clouded mental functions, nausea, vomiting, spontaneous abortion.  It is used medicinally for the suppression of pain, though under controlled conditions. In addition, heroin can cause temporary feelings of euphoria.  Long term effects include addiction and infectious diseases such as HIV, AIDS, hepatitis B and C, collapsed veins, bacterial infection, abscesses,  arthritis and pneumatic problems.

In Western medicine there are many types of detoxification programs.

1. The methadone is the most popular.  Methadone is a synthetic opioid that blocks the effects of the heroin and eliminates withdrawal symptoms; this method has a proven record of success for heroin addicts.
2. A pharmaceutical approach is the use of buprenorphine as another behavioral therapy.  Buprenorphine offers less risk than methadone and can be prescribed in the doctor’s office.  Bupherorphine and Suboxone is a combination drug product formulated to minimize abuse.

Chinese medicine and acupuncture have a long history of treating drug abuse.  The two types of treatments are:

1. Auricular acupuncture
2. Body acupuncture.

The main functions of the acupuncture treatment are to decrease the withdrawal symptoms and improve the patient’s depression and brain function.  There are many studies supporting these treatments and the most well known is that acupuncture can directly increase the level of endogenous endorphin, which makes the patient feel calm, relaxed and cheerful.  Acupuncture can also directly stimulate the central nervous system to make the patient feel less depressed and lessen the craving for drugs.

For auricular acupuncture, I use the lung, endocrine, liver, spleen and large intestine points corresponding to these organs. .  The lung has an opening through the nose and when people abuse heroin, the lung point will protect the lung function and strengthen the immune system.   The endocrine points increase endorphin secretion and increase people’s immune function to protect the entire body.  Liver and spleen points improve circulation and also improve the taste in the mouth because the spleen and stomach have openings in mouth and large intestine points; the intestine and the lung have direct meridian connection, so if we improve the function of the large intestine, this in turn will directly improve the lung function.

Pic 6-1

For the body acupuncture points, the most important ones are on the head. I use Baihui DU20 plus shi sheng chong Exn1, total five points, which can directly stimulate the central nervous system when I add electrical stimulation to the needles.  They send current directly to the cortex of the brain, which greatly improves the patient’s mood and decreases the depression.  Shuaigu GB8, which is on the head 1.5 inches above the tip of the auricular is directly connected to the sensory cortex, which will improve the body’s sensation and make it dislike the taste of heroin.  Hegu L14 is a point that can largely increase endorphin secretion and Qu Chi L111 will give a better functioning effect.  Neiguan Pc6 is a point of the pericardium meridian, which also helps improve mental functions.  Lu7 is the point from the lung meridian which protects the lung from attacks of heroin and improves the immune function of the lung.

Pic 6-2

After treatment of two weeks, the patient started to feel decreased withdrawal symptoms and had more energy.  However, he sometimes still feels cravings for heroin, and he has some physical weakness, with muscle spasms in his arms and legs.  He also experienced restlessness and agitation, often accompanied by insomnia.  I continued the acupuncture treatments three to four times a week for eight weeks, while also discussing the short and long term effects of heroin use and what organs would be effected and harmed by continued use.  He told me that, in spite of the withdrawal symptoms, he still felt much better with the treatments and he is happy to treat his addiction in this fashion, rather than go into a methadone program, at which point his drug use would become generally known.  By coming to me, he can be treated in private for his addiction.

Peter W. was also advised to make lifestyle adjustments and I encouraged him to work more for the charity.  He traveled to Africa and Asia to actually see and meet the people using the inexpensive computers, and what it could do to improve their lifestyles.  This experience touched him a great deal and after about 3 months of treatment he stopped using heroin entirely and is now completely clean.  His insomnia, depression, anxiety and other symptoms are much improved and he is leading a normal life again.

Autumn is here. We hope you are enjoying the wonderful color of the season.

Now, it is the time for our News Letter 10. President Obama declared Swine Flu an emergency. We will describe the updated info about swine flu in the News Letter 10. Please enjoy the info we provide, it might help you for your family members or friends. You may call our office at 203-637-7720 for further info. Please feel free to forward this news letter to somebody you concern, as long as it is not  for commercial use. As you know, this news letter is copyrighted.

Best wishes,

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

News Letter, Vol. 1 (10), October, 2009, © Copyright

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

www.rmac.yourmd.com;

www.drxuacupuncture.com

Rehabilitation
Medicine and Acupuncture Center

1171 East
Putnam Avenue, Building 1, 2^nd Floor

Greenwich, CT 06878

Tel: (203) 637-7720

New Info About Swine Flu

President Obama declared the swine flu an emergency. However, please do not be panic, here is the most updated info about Swine, and I will instruct you what you should prepare for this emergency in this news letter.

During the week of October 11-17, 2009, a review of the key indictors found that influenza activity continued to increase in the United States from the previous week according to the data from Centers for Disease Control and Prevention.

• Visits to doctors for influenza-like illness (ILI) increased steeply since last week in the United States, and overall, are much higher than what is expected for this time of the year.

• Total influenza hospitalization rates for laboratory-confirmed flu are climbing and are higher than expected for this time of year.

• The proportion of deaths attributed to pneumonia and influenza (P&I) based on the 122 Cities Report has increased and has been higher than what is expected at this time of year for two weeks. In addition, 11 flu-related pediatric deaths were reported this week; 9 of these deaths were confirmed 2009 H1N1, and two were influenza A viruses, but were not subtyped. Since April 2009, CDC has received reports of 95 laboratory-confirmed pediatric 2009 H1N1 deaths and another 7 pediatric deaths that were laboratory confirmed as influenza, but where the flu virus subtype was not determined.

• Forty-six states are reporting widespread influenza activity at this time. They are: Alabama, Alaska, Arizona, Arkansas, California, Colorado, Delaware, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Dakota,
  Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, and Wyoming. This many reports of widespread activity are unprecedented during seasonal flu.
• Almost all of the influenza viruses identified so far are 2009 H1N1 influenza A viruses. These viruses remain similar to the virus chosen for the 2009 H1N1 vaccine, and remain susceptible to the antiviral drugs oseltamivir and zanamivir with rare exception.

What should you do? Please find the following common Q & A:

Are there human infections with 2009 H1N1 virus in the U.S.?

Yes. Human infections with 2009 H1N1 are ongoing in the United States. Most people who have become ill with this new virus have recovered without requiring medical treatment.

Is 2009 H1N1 virus contagious?

The 2009 H1N1 virus is contagious and is spreading from human to human.

How does 2009 H1N1 virus spread?

Spread of 2009 H1N1 virus is thought to occur in the same way that seasonal flu spreads. Flu viruses are spread mainly from person to person through coughing or sneezing by people with influenza. Sometimes people may become infected by touching something – such as a surface or object – with flu viruses on it and then touching their mouth or nose.

What are the signs and symptoms of this virus in people?

The symptoms of 2009 H1N1 flu virus in people include fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills and fatigue. Some people may have vomiting and diarrhea. People may be infected with the flu, including 2009 H1N1 and have respiratory symptoms without a fever. Severe illnesses and deaths have occurred as a result of illness associated with this virus.

What can I do to protect myself from getting sick?

This season, there is a seasonal flu vaccine to protect against seasonal flu viruses and a 2009 H1N1 vaccine to protect against the 2009 H1N1 influenza virus (sometimes called “swine flu”). A flu vaccine is the first and most important step in protecting against flu infection. Please call your PCP for the vaccine, which should be available since November 1, 2009.

There are also everyday actions that can help prevent the spread of germs that cause respiratory illnesses like the flu.

Take these everyday steps to protect your health:

Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.

• Wash your hands often with soap and water. If soap and water are not available, use an alcohol-based hand rub.*
• Avoid touching your eyes, nose or mouth. Germs spread this way.
• Try to avoid close contact with sick people.
• If you are sick with flu-like illness,
  
  CDC recommends that you stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities. (Your fever should be gone without the use of a fever-reducing medicine.) Keep away from others as much as possible to keep from making others sick.

Who will be recommended to receive the 2009 H1N1 vaccine?

CDC’s Advisory Committee on Immunization Practices (ACIP) has recommended that certain groups of the population receive the 2009 H1N1 vaccine when it first becomes available. These target groups include pregnant women, people who live with or care for children younger than 6 months of age, healthcare and emergency medical services personnel, persons between the ages of 6 months and 24 years old, and people ages of 25 through 64 years of age who are at higher risk for 2009 H1N1 because of chronic health disorders or compromised immune systems. If  you are not in the above category, you may not need the vaccine. You many need to take steps with the recommendations in this article.

Other important actions that you can take are:

• Follow public health advice regarding school closures, avoiding crowds and other social distancing measures.
• Be prepared in case you get sick and need to stay home for a week or so; a supply of over-the-counter medicines, alcohol-based hand rubs * (for when soap and water are not available), tissues and other related items could help you to avoid the need to make trips out in public while you are sick and contagious.

What is the best way to keep from spreading the virus through coughing or sneezing?

If you are sick with flu-like illness, CDC recommends that you stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities. (Your fever should be gone without the use of a fever-reducing medicine.)

Keep away from others as much as possible. Cover your mouth and nose with a tissue when coughing or sneezing. Put your used tissue in the waste basket. Then, clean your hands, and do so every time you cough or sneeze.

If I have a family member at home who is sick with 2009 H1N1 flu, should I go to work?

Employees who are well but who have an ill family member at home with 2009 H1N1 flu can go to work as usual. These employees should monitor their health every day, and take everyday precautions including covering their coughs and sneezes and washing their hands often with soap and water, especially after they cough or sneeze. If soap and water are not available, they should use an alcohol-based hand rub.* If they become ill, they should notify their supervisor and stay home. Employees who have an underlying medical condition or who are pregnant should call their health care provider for advice, because they might need to receive influenza antiviral drugs. For more information please see General Business and Workplace Guidance for the Prevention of Novel Influenza A (H1N1) Flu in Workers.

What is the best technique for washing my hands to avoid getting the flu?

Washing your hands often will help protect you from germs. CDC recommends that when you wash your hands — with soap and warm water — that you wash for 15 to 20 seconds. When soap and water are not available, alcohol-based disposable hand wipes or gel sanitizers may be used.* You can find them in most supermarkets and drugstores. If using gel, rub your hands until the gel is dry. The gel doesn’t need water to work; the alcohol in it kills the germs on your hands.

What are “emergency warning signs” that should signal anyone to seek medical care urgently?

In children:

• Fast breathing or trouble breathing
• Bluish skin color
• Not drinking enough fluids
• Not waking up or not interacting
• Being so irritable that the child does not want to be held
• Flu-like symptoms improve but then return with fever and worse cough
• Fever with a rash

In adults:

• Difficulty breathing or shortness of breath
• Pain or pressure in the chest or abdomen
• Sudden dizziness
• Confusion
• Severe or persistent vomiting

What should I do if I get sick?

If you get sick with flu-like symptoms this flu season, you should stay home and avoid contact with other people except to get medical care. Most people with 2009 H1N1 have had mild illness and have not needed medical care or antiviral drugs and the same is true of seasonal flu.

However, some people are more likely to get flu complications and they should talk to a health care provider about whether they need to be examined if they get flu symptoms this season. They are:

• Children younger than 5, but especially children younger than 2 years old
• People 65 and older
• Pregnant women
• People who have:
  • Cancer
  • Blood disorders (including sickle cell disease)
  • Chronic lung disease [including asthma or chronic obstructive pulmonary disease (COPD)]
  • Diabetes
  • Heart disease
  • Kidney disorders
  • Liver disorders
  • Neurological disorders (including nervous system, brain or spinal cord)
  • Neuromuscular disorders (including muscular dystrophy and multiple sclerosis)
  • Weakened immune systems (including people with AIDS)

Also, it’s possible for healthy people to develop severe illness from the flu so anyone concerned about their illness should consult a health care provider.

There are emergency warning signs. Anyone who has them should get medical care right away.

What are the emergency warning signs?

In children

• Fast breathing or trouble breathing
• Bluish skin color
• Not drinking enough fluids
• Not waking up or not interacting
• Being so irritable that the child does not want to be held
• Flu-like symptoms improve but then return with fever and worse cough
• Fever with a rash

In adults

• Difficulty breathing or shortness of breath
• Pain or pressure in the chest or abdomen
• Sudden dizziness
• Confusion
• Severe or persistent vomiting

Do I need to go the emergency room if I am only a little sick?

No. The emergency room should be used for people who are very sick. You should not go to the emergency room if you are only mildly ill. If you have the emergency warning signs of flu sickness, you should go to the emergency room. If you get sick with flu symptoms and are at high risk of flu complications or you are concerned about your illness, call your health care provider for advice. If you go to the emergency room and you are not sick with the flu, you may catch it from people who do have it.

Are there medicines to treat 2009 H1N1?

Yes. There are drugs your doctor may prescribe for treating both seasonal and 2009 H1N1 called “antiviral drugs.” These drugs can make you better faster and may also prevent serious complications. This flu season, antiviral drugs are being used mainly to treat people who are very sick, such as people who need to be hospitalized, and to treat sick people who are more likely to get serious flu complications. Your health care provider will decide whether antiviral drugs are needed to treat your illness. Remember, most people with 2009 H1N1 have had mild illness and have not needed medical care or antiviral drugs and the same is true of seasonal
flu.

How long should I stay home if I’m sick?

CDC recommends that you stay home for at least 24 hours after your fever is gone except to get medical care or for other things you have to do and no one else can do for you. (Your fever should be gone without the use of a fever-reducing medicine, such as Tylenol®.) You should stay home from work, school, travel, shopping, social events, and public gatherings.

What should I do while I’m sick?

Stay away from others as much as possible to keep from making them sick. If you must leave home, for example to get medical care, wear a facemask if you have one, or cover coughs and sneezes with a tissue. And wash your hands often to keep from spreading flu to others. CDC has information on “Taking Care of a Sick Person in Your Home” on its website at:

http://www.cdc.gov/h1n1flu/guidance_homecare.htm

Are there medicines to treat 2009 H1N1 infection?

Yes. There are drugs your doctor may prescribe for treating both seasonal and 2009 H1N1 called “antiviral drugs.” These drugs can make you better faster and may also prevent serious complications. This flu season, antiviral drugs are being used mainly to treat people who are very sick, such as people who need to be hospitalized, and to treat sick people who are more likely to get serious flu complications. Your health care provider will decide whether antiviral drugs are needed to treat your illness. Remember, most people with 2009 H1N1 have had mild illness and have not needed medical care or antiviral drugs and the same is true of seasonal
flu.

How long can influenza virus remain viable on objects (such as books and doorknobs)?

Studies have shown that influenza virus can survive on environmental surfaces and can infect a person for 2 to 8 hours after being deposited on the surface.

What kills influenza virus?

Influenza virus is destroyed by heat (167-212°F [75-100°C]). In addition, several chemical germicides, including chlorine, hydrogen peroxide, detergents (soap), iodophors (iodine-based antiseptics), and alcohols are effective against human influenza viruses if used in proper concentration for a sufficient length of time.

*What if soap and water are not available and alcohol-based products are not allowed in my facility?

If soap and water are not available and alcohol-based products are not allowed, other hand sanitizers that do not contain alcohol may be useful.

What surfaces are most likely to be sources of contamination?

Germs can be spread when a person touches something that is contaminated with germs and then touches his or her eyes, nose, or mouth. Droplets from a cough or sneeze of an infected person move through the air. Germs can be spread when a person touches respiratory droplets from another person on a surface like a desk, for example, and then touches their own eyes, mouth or nose before washing their hands.

How should waste disposal be handled to prevent the spread of influenza virus?

To prevent the spread of influenza virus, it is recommended that tissues and other disposable items used by an infected person be thrown in the trash. Additionally, persons should wash their hands with soap and water after touching used tissues and similar waste.

How can  acupuncture and Chinese herb help for prevention of swine flu?

There are many Chinese herbs and acupuncture treatment currently using in China. However, there is no specific evidence that Chinese herb and acupuncture may help. You may ask Dr. Xu directly in person about the specific questions.

The above info is cited mostly from the CDC website: http://www.cdc.gov/h1n1flu/

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

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

Rehabilitation Medicine and Acupuncture Center

1171 East Putnam Avenue, Building 1, 2^nd Floor

Greenwich, CT 06878

Tel: (203) 637-7720

Smoking Cessation

Jackson W, a 56 year old male, is president and CEO of a large company.  When he consulted me it was due to his habit of smoking 2 packs of cigarettes a day for the past 45 years.  Now he has shortness of breath and heart palpitations and he is afraid he may have lung cancer.  He came to me hoping I could help him quit.

He is a heavy-set man who comes down hard on his feet and legs while walking, he has yellowish facial skin and smells of cigarettes, especially on his breath.  He says he feels energetic and, by listening to his lungs, I ascertained there was no wheeze, no cloud sound from the lung and his heartbeat was normal.  In giving his history, Jackson told me he had been in the army, and after his tour of duty returned to the United States where he started to work.  Since he never went to college, he knew he had to work extremely hard to beat his competitors, and he roused both himself and his son, by telephone as he worked in a different city, at six .am., at which time he went to work, often not returning home until 10 p.m.  He worked like this seven days a week which, in the beginning was doable.  However, recently, he felt he did not have the stamina to keep up this schedule, and he was afraid he might die of smoking and working so hard, to he came to me for help.

I discussed with Jackson the absolute necessity to stop smoking, because cigarettes contain the drug nicotine, which is as highly addictive as heroin or cocaine.  Over time, the smoker becomes physically and emotionally to it and totally dependent on nicotine.  Many men think nicotine gives them the energy to support their lives, while many women believe cigarettes make and keep them thin.  Studies have shown that smokers must deal with both physical and psychological dependence to be successful at quitting and staying quit.

When a smoker inhales, nicotine is carried deep into the lungs where it is absorbed quickly into the bloodstream and carried throughout the body.  Nicotine affects many parts of the body, including the heart and blood vessels, hormonal system, metabolism and brain.  Nicotine can be found in breast milk and even in cervix mucus secretions of smokers.  Nicotine can freely enter the placenta during pregnancy and affect newborn infants.

Nicotine produces pleasant feelings that makes the smoker want to smoke more and more, and after awhile the smoker develops a tolerance to it, which brings an increase in smoking over time.  The smoker reaches a certain nicotine lever and then smokes to maintain this level.

Currently all medical research indicates that many severe diseases are caused by smoking.  These include bronchitis, emphysema and even lung cancer, which makes many smokers try to cut back or quit altogether.  However, as soon as the smoker actually does quit  – for a few hours or a few days – withdrawal symptoms occur, including dizziness, depression, feelings of frustration, impatience, anger, irritability, sleep disturbance, increased appetite, trouble concentrating, headache, tiredness and restlessness.  All these symptoms can lead to the smoker starting again in order to boost blood levels of cigarettes back to the level where there are none of these symptoms.

I discussed all these issues about health with Jackson in an effort to make him understand why he must quit.

1.  Almost everyone understands that smoking can cause lung cancer, however, many other cancers can be introduced through smoking: cancer of the mouth, vocal cord, affecting the larynx, throat, pharynx, esophagus, bladder, kidneys, pancreas, cervix, stomach and leukemia.

2. Lung disease can lead to pneumonia, chronic obstructive pulmonary disease (COPD) and chronic bronchitis.

3.  Smoking can also lead to heart attack, stroke, blood vessel disease and blindness.

Chinese medicine believes that cigarette smoking falls into three major types:

1. Type 1 is Energy deficiency of the heart and lung, which includes bronchitis, emphysema, coronary artery disease and insomnia.  The main symptoms are cough, asthmatic attacks, chest pain, sore throat, shortness of breath, agitation, anxiety, poor sleep, insomnia and dreaming.
2. The second type is Yin deficiency of the liver and kidney, which includes high blood pressure and insomnia.  The main symptoms include dizziness, faintness, tinnitus, impotence, early ejaculation or night ejaculation, dysmenorrheal and infertility.
3. The third type is Weakness and deficiency of the spleen and stomach, which includes chronic gastritis and peptic ulcer.  The main symptoms include stomach ache, bloating, poor appetite, loose diarrhea, heaviness of the body, drowsiness and headache.

4. Treatment

(1) Auricular acupuncture treatment, i.e. Ear embedding needles.  First we find the most painful points on the ear, those usually corresponding to the heart and sympathetic system. I regularly use Sheng Meng, Heart, Lung, Endocrine and Large Intestine. I insert the needles at the auricular points.  These needles stay in  the ear for seven days and every day the patient presses the needles for 4 to 5 minutes per hour, which lessens the craving for the nicotine in a cigarette.  He also presses the needles anytime he gets the urge to smoke.  It is possible to bathe or shower with the needles imbedded in the ear, but the patient must be on the alert for any signs of inflammation or infection.

(2) Laser treatment. Laser needles can also be used on the auricular acupuncture points. aiming directly at the ear for usually 2 to 3 mm.  For each treatment, four pints are used for 15 minutes each time, with the total treatment about 25 to 30 minute.  This is done 3 times a week for 4 to 8 weeks.

1. Auricular acupuncture point injections. 0.5% sodium chloride can be injected for each day one or two points, always changing the points after each injection. Endocrine, sheng meng, stomach, liver and lung points are often used.
2. Electrical stimulation for the ear. I usually select sheng meng, lung and endocrine, and use a 1 inch needle in both ears and do six points, then employ electrical stimulation for about 30 minutes and continue this treatment every other day for a total of  four weeks.
3. Body acupuncture. Emotional burden, such as stress, anxiety, poor sleep and depression can force many people to smoke, therefore, body acupuncture can help to reduce emotional problem.

1, Type 1: Energy deficiency of the heart and lung,  auricular points are heart, sympathetic, sheng meng, body points are Zhong Fu, Ju Que, Nei Guan, Fei Shu, Xin Shu, San Yin Jiao, Chi Zhe.

Pic 5-1

2, Type 2: Yin deficiency of the liver and kidney Auricular points are Liver, Kidney, Sheng Mend, Endocrine, body points are Jing Meng, Xing Jian, Tai Xi, Gan Shu, Bai Hui, Shui Quan.

Jackson was treated with both ear and body acupuncture.  He had three treatments a week for eight weeks, and after the first week he reduced his intake to one pack of cigarettes a day and the second week he stopped smoking. After the total time of eight weeks he was completely off cigarettes.

In my experience, the first two weeks are the most crucial time for the patient, because the nicotine withdrawal syndrome is the most severe and the patient is depressed, agitated, sometimes anxious and suffering from insomnia, and any of these can cause a return to smoking.  If I treat the patient with ear acupuncture, he can constantly press the needles embedded in the ear, which will decrease his craving for a cigarette and will enforce the psychological support. If the patient knows all the consequences of smoking, and desires to quit, he usually can do so with acupuncture.  Most succeed with the right attitude toward the consequences of continuing to smoke.

Tips for acupuncturists:

1. Education, education! This is the most important part. If the patient is not willing to quit, there is no way to force the patient to quit.
2. Encouragement: You have to encourage the patient to stick to the program.
3. Support: you have to get support from the patient’s family and friends.

Tips for patients:

1. Be determined and stick to the program: the first 2 weeks are the most difficult time. If you can stick to it, you will win the war.
2. Think about your future and your family’s future, you do not want to set up a wrong role model for your children and family members.

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.com

Rehabilitation Medicine and Acupuncture Center

1171 East Putnam Avenue, Building 1, 2^nd Floor

Greenwich, CT 06878

Tel: (203) 637-7720

Case Discussion: Allergy and Sinusitis

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.

There 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

Table 4-1

Notes: 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.com for the location and photos of the acupuncture points.

Pic 4-2

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

Acupressure 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

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.

Pic 4-4

Initially 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.

Have a nice summer!

Now, it is the time for our News Letter 7. We will describe the bronchitis and its medical and acupuncture treatments in the News Letter 7. Please enjoy the info we provide, it might help you for your family members or friends. You may call our office at 203-637-7720 for further info.

Best wishes,

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

News Letter, Vol. 1 (7), July, 2009, © Copyright

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

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

Rehabilitation Medicine and Acupuncture Center

1171 East Putnam Avenue, Building 1, 2^nd Floor

Greenwich, CT 06878

Tel: (203) 637-7720

Case Discussion: Asthma

Jimmy S is a 12-year-old boy who came to my office after a sudden onset of   shortness of breath and tightness in the chest.  In addition he said he had occasional pain and trouble in sleeping and, by listening to his lungs, I heard audible wheezing.  He sometimes had coughs as well, and his mother reported he first developed these symptoms when he was 2 years old.  The incidents happened mostly in cold weather, and sometimes when he ran or participated in sports.  At these times he had difficulty in breathing, often coughed or wheezed and all this together brought about a diagnosis of asthma.  His doctor prescribed an inhaler and other medication, which, for a while, made his asthma better.  However, for the past decade, though he used these asthma-aids, he still had frequent attacks.  These made him miss classes which bothered him, as he wanted to keep up with his schoolmates.  His primary care physician could give him no further help, at which time he consulted me.

What causes asthma?

Asthma is an inflammation and constriction of the lungs and airways, including brachial tubes. Asthma is usually triggered by cold, allergens, including dust, mould, perfume, fur, etc, respiratory infection such as the common cold and physical activity such as exercise, cold air and irritants such as smoke.  Certain medications also can trigger asthma, such as aspirin and non-steroid anti-inflammatory drugs, as well as strong emotion, stress, gastroesophageal reflux disease, menstrual cycles and allergic reactions to certain foods.  After exposure to these irritants, the airways produce extra mucus that blocks them and makes the brachial wall muscle tighten and constrict, which causes all the symptoms of asthma such as cough, shortness of breath and wheezing.  If symptoms become worse, some patients will get an infection which will produce yellowish sputum and this infection will cause more severe symptoms.  Asthma is usually worse in the morning and late at night.  In between asthmatic episodes, symptoms have been known to disappear or improve, but this does not mean the asthma has gone away, which is why Jimmy S has had these symptoms for more than ten years.

Resource: http://www.rainbowskill.com/wp-content/uploads/2009/03/asthma1.jpg

There are four types of asthma:

1. Allergic asthma, caused by the airway inflammation when exposed to allergens, such as dust, mould, smoking, fur, perfume, food, etc.
2. Exercise-induced asthma, which is triggered by vigorous activity.
3. Cough-variant asthma, which produces a chronic and persistent cough, sometimes called a habitual cough, without shortness of breath.
4. Occupational asthma, caused by exposure to certain stimulants, such as certain chemicals, oils, gas, etc.  in the workplace.

From the Western point of view, the treatment of asthma includes two types of medication:

1. Bronchodilators such as beta-agonist, albuterol and salmeterol and also anticholinergics such as ipatropium.  These two types of medications can dilate the respiratory tubes and open the lungs to air.
2. Corticosteroid.  The inhaled corticosteroid is recommended for most patients and is most effective for the respiratory tract and with minimal effect on the rest of the body at normal doses.  These are good for short-term relief if inhaled or given by injection to speed up the resolution of airway inflammation.

It is strongly recommended for people with asthma to carry their inhalers with them, in case any emergency happens to them. The above precaution sometimes plays a role of life or death. However, for a long term treatment, the Chinese medicine might help more.

Chinese Medicine Diagnosis and Treatment

Asthma is characterized by repeated attacks of paroxysmal dyspnea with wheezing.  It can be divided into two types, deficiency and excess.

Type I:  Excess

1.       Wind-cold type.  This kind of asthma attack is due to the invasion of wind-cold pathogen from environment which impairs the smooth flow of the lung qi (energy), injures the skin and hair and makes the lung respiratory tract, especially the bronchial tract, closed or restricted.    Since the lung and the body surface  defense system are weakened, the lung qi fails to disperse and descend which leads to a cough.

2.       Phlegm-heat type.  This type asthma is due to the failure of the spleen in transformation and transportation resulting in the production of phlegm from accumulated dampness, finally ending in retention of phlegm which turns into heat or excessive fire of the lung which evaporates the fluids which caused the  accumulation of phlegm.  The phlegm stays in the lungs with hotness, causing the lung energy to stagnate, which causes the impairment of the lung’s proper function, then causes asthma.

Type II:  Deficiency

1. Lung deficiency.  A prolonged and protracted cough usually weakens and injures the lung energy, and strain of an internal lung and respiratory muscle can also bring about deficiency of the lung energy.  In either case, shortness of breath and dyspnea may occur.
2. Kidney deficiency.  Since the kidney is the energy resource of the human body, longstanding asthma, overwork and other factors will affect the kidney function, therefore, if kidney deficiency is present, its energy cannot support lung functions, which will induce weakness of the kidney and make an asthma attack that much more severe.

Treatment:

1. For wind-cold type the principal is to eliminate the exogenous pathogens as well as improve the lung’s function and enrich the lung’s energy.

Prescription:  UB13 Fei Shu, UB12 Feng Men, Du14 Da Zhui, Lu 7 Lie Que, LI 4 He Gu.

Acupressure tips for patients:

1. The most important points are UB 12, UB 13 and Du 14.
2. Press UB 13 for 5 min with both your knuckles, then UB 12 for another 5 min, alternate for about 3 times might help you to reduce the asthmatic symptom and the patient might feel relief from the acupressure self treatment.

Acupuncture tips for practitioners:

1. Electrical stimulation on UB 12, UB 13 and Du 14.
2. Ultra Red Heating Lamp on UB 12, UB 13 and Du 14 for 20 to 30 min.

3. UB13 and UB12 are located in the vicinity of the lung, which will greatly improve the lung’s function and energy and will protect the lung from the exogenous pathogens attacking.  They will clear the lung and eliminate the wind.  DU14, Lu 7 and LI4 function to eliminate the wind-cold and clear the lung, therefore soothing the asthma.

1. Phlegm heat:  Because phlegm heat shows signs of mild infection of the lung, there are more points to choose from for eliminating the exogenous pathogens such as wind heat.

Prescription:  UB13  Fei Shu, EX-B1 Ding Chuan,   Ren 22 Tian Tu, and Lu 5 Chi Ze , St 40  Feng Long.

Table 3-2

Acupressure tips for patients:

1. Press hard on bilateral EX-B1 Ding Chuan for 5 min, then UB 13 Fei Shu for 5 min, alternate for 2 sessions.
2. Ren 22 Tian Tu may also help to decrease the asthma after pressing for about 5 min.

Acupuncture tips for practitioners:

1. No heating lamp.
2. Use all above 5 points and electrical stimulation for 20 to 30 min. If they are pairs, you should use the paired points also.

3.  Lu 5 Chi Ze is very important to reduce the phlegm heat and soothe the brachial smooth muscle.  Fenlong S40 is a point of strengthening the spleen function which resolves the problem of phlegm.

4. UB13 Fei Shu is applied to clear the lung and regulate the flow of energy.  Ren 22 Tian Tu causes the energy to subside and resolves the problem of phlegm, as well as eliminating excessive heat.  Dingchaun is the point which causes a cessation of wheezing and makes breathing much easier.

Type II:  Deficiency Type:

Lung deficiency: The lung is the vital internal organ to regulate respiration. Lung energy deficiency leads to the easy entry of the pathogens, and causes asthma. The goal is to improve the lung energy and efficiency and decrease the chance of the body being attacked by exogenous pathogens.

Prescription:  UB13 Fei Shu, Lu 9 Tai Yuan, St 36 Zu San Li and Sp 3 Tai Bai.

Table 3-3

Acupressure Tips for patients:

1. For long term health care, always press St 36 and UB 13, even you do not have any illness; these two points will protect you from the attack of external pathogenesis.
2. Lu 9 and Sp 3 for acute attack.

Acupuncture Tips for practitioners:

1. Heating Lam should be used for St 36 and UB13.
2. Electrical stimulation for LU 9 and Sp 3.
3. Lu 9 Tai Yuan is the beginning point of the lung meridian and is able to reinforce the lung energy.  UB13 Fei Shu, used in both acupuncture and moxibustion, can strengthen the lung energy,  and St 36 Zu san li S36 is the key point of the stomach meridian, which can greatly improve the immune system and energy of the entire human body.
4. Sp 3 Tai Bai  is the first point of the spleen meridian.   The spleen can greatly improve the lung’s breathing function, therefore, Sp 3 can both clean out the phlegm and relax the smooth muscle of the brachial tract.  St 36 and SP 3 combined will strengthen the lung and improve the function of the spleen and stomach.

Kidney Deficiency:

The kidney is the energy manufacturer of the entire human body. Any lessening of its function will cause a decrease of the immune function and energy flow of daily activity.  For this reason it is necessary to strengthen the kidney.  UB13 Fei Shu, REN17 Tan Zhong,  K3 Tai Xi  and UB23 Shen Shu, and REN 6 Qi Hai are selected.

Table 3-4

Acupressure Tips for patients:

1. UB 23 is the key point to press.
2. UB 13 and Ren 17 will greatly help in  strengthening the kidney function.

Acupuncture Tips for practitioners:

1. Heating Lamp should be used for UB 23 and UB 13.
2. Electrical stimulation for UB23, Ren 17 and Ren 6.
3. Ki 3 Tai Xi strengthens the primary energy of the kidney and, when combined with UB23 Shen Shu, the original point adjacent to the kidney, it will greatly enhance the Ki 3 functions.  REN17 Tan Zhong  is one of the most important energy points in the eight influential points and UB13 Fei Shu is the back-shu point of the lung which reinforces energy and smoothes out ragged breathing.  Ren 6 Qi Hai is an important point to reinforce lung energy and recreate energy in the lower lung respiratory track and also strengthens the kidney and primary energy.

Tips for patients and practitioners:

Asthma attacks usually happen in fall, winter and spring, and only occasionally in the summer. Based on traditional Chinese medicine, summer is the most important season to reinforce the kidney and spleen Yang energy.  I insist patients having treatments during the summer. I use not only acupuncture but also moxibustion, i.e. Moxa during summer.  One treatment in summer is probably the equivalent of four or five treatments at any other season.  Utilizing the previously cited points in acupuncture, it is possible to alleviate chronic asthmatic symptoms by strengthening the energy and improving function of spleen, as well as that of the stomach and kidneys.  In this way it is possible to relieve, or even eradicate future attacks.

Jimmy S received a dozen treatments from me during the first summer.  During the school year, he worked very hard at his studies. His summer treatments helped him so much that he only needed to consult me each summer for a few visits.

Time flies! Now it is the time for our news letter 6, bronchitis. You may find some useful info for your reference. So far, we have sent out total 6 news letters in this year. If you or your friends would like to read previous news letters, please visit: www.drxuacupuncture.com. You are welcome to forward our news letters to your friends. Here are the titles of all of the previous case discussions:

1. Unexplained infertility

2. Headaches

3. Weight control

4. Osteoporosis

5. Common cold

Thank you very much and have a wonderful July 4^th!

Best wishes,

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

News Letter, Vol. 1 (6), June, 2009, © Copyright

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

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

Rehabilitation Medicine and Acupuncture Center

1171 East Putnam Avenue, Building 1, 2^nd Floor

Greenwich, CT 06878

Tel: (203) 637-7720

Case Discussion: Bronchitis

Susan W., a 45-year-old female. came to my office complaining of a severe cough which had lasted for about three or four weeks.  It caused her tremendous pain on her chest and abdominal muscle and she also coughed out yellowish greenish phlegm and sometimes experienced wheezing and shortness of breath; she also was running a low fever and had chills and  muscle aches.  She also suffered nasal congestion and sore throat and had difficulty swallowing  food.  Her ears were blocked, making it  difficult to hear, and she was extremely uncomfortable in many areas when she came to me for evaluation and treatment.

This patient most likely had bronchitis, an irritation and inflammation of the airways.  It is often triggered by the upper respiratory tract infection such as the common cold or influenza, and can also be caused by sinus infection, as well as exposure to irritating fume or dust or fur of cats or dogs or tobacco smoke.  According to Western medicine, there are five types of bronchitis based on western medicine:

1.         Acute bronchitis.  It will last about several days to weeks and usually it will clear up on its own.

2.         Viral bronchitis.  This is triggered by viral infection such as common cold.

3.         Occupational bronchitis.  Patients are exposed to lung irritants in one’s home or work place and the treatment usually is withdraw from the place.

4.         Chronic bronchitis.  The above symptoms will last for longer than three months or recur at a frequency over period of years so this chronic bronchitis usually is not caused by infection but is very often associated with chronic obstructive pulmonary disorder.

5.         Asthmatic bronchitis refers to the same symptoms but the underlying cause is asthma.

Traditional Chinese medicine believes bronchitis is a lung disease which results either from attack of the exogenous pathogenic factors or from disorders of the lung itself.

For the invasion of the exogenous pathogenic factors, there are two types:

1.  Wind cold: The main manifestations are cough, itching in the throat, thick white sputum, and the patient is easily susceptible to cold, with symptoms such as fever,  anihidrosis, headache, nasal obstruction and discharge with thin white tongue coating, and superficial pulse.

2. Wind heat:  The main manifestations are choking cough with yellowish thick sputum, thirst, sore throat, fever, headache, and  the patients are aversion to wind and with symptom of sweating, with thin yellow tongue coating and superficial and rapid pulse.

For the internal organ injury of the lung, there are two types.

1. Blockage of the lung by  phlegm.  The main manifestation is cough with profuse, thick white sputum and stuffiness and congestion of the chest, loss of appetite, white sticky tongue coating, and rolling pulse.

2. Dryness of the lung with deficiency of yin.  This is manifested  by dry cough without sputum or with scanty sputum, dryness of the nose and throat, sore throat, spitting – or even – coughing of blood, afternoon fever, malar flash, red tongue, with thick tongue coating, and rapid pulse.

Treatment:Western medicine.

By far the majority of bronchial cases are originally from viral infections, this means that most cases of bronchitis are short term and require nothing more than symptomatic treatment.  Since antibiotics do not cure a viral illness, overuse of antibiotics  will make the bacteria habituated in the respiratory tract resistant to the antibiotics currently available.  Many doctors  prescribe antibiotics because they feel pressure from the patients. If they do not prescribe certain antibody, then the patient will think the doctor did nothing to help.

We can use acetaminophen to control the fever, such as,  Tylenol, aspirin, or ibuprofen.  Also the patient should drink as much  fluid as possible in order to clear the body, dilute the virus and to make the virus dissipate in the body’s  fluid.  A humidifier might also help and over-the-counter cough suppressants such as the Robitussin  and Mucinex might also assist in loosening the secretions.

Bronchodilator inhalers will help open airways and decrease the wheezing. If there is bacterial infection, then antibiotics should be prescribed.

Traditional Chinese medicine and acupuncture treatments:

1.         For wind cold.  You may choose acupuncture points such as Lu 7 Lie Que, LI 4 He Gu, and UB13 Fei Shu (Lung Shu), and with supplementary points for pain and swelling of the throat, Lu11 Shao Shang, and for fever and aversion to cold Du14 Da Zhui and SJ 5 Wai Guan.

Pic 2-1

Table 2-1

2.         For wind heat: UB 13 Fei Shu, Lu 5 Chi Ze, Du 14 Da Zhui, LI 11 Qu Chi.

Pic 2-2

3.         For the internal lung injury with the blockage of the lung by phlegm, so we select back-shu points and other lung points: like UB13 Fei Shu, Ren 12 Zhong Wan, Lu 5 Chi Ze, St 36 Zu San Li, St 40 Feng Long.

Pic 2-3                                                                                             Pic 2-4

Acupressure tips for patients:

1.      The most important points are Fei Shu, UB 13. Ask your friend or family member press the points on both side for 5 min each, alternately press until you feel energy flow go through your lung.

2.      If you have fever or feel very cold, press Da Zhui, Du 14 for 10 min, then press Fei Shu. UB 13, which will greatly improve  your immune ability and quickly decrease your cough and respiratory symptom, such as cough, sneeze, etc.

Acupuncture tips for acupuncture practitioners:

1.      Always electrically stimulate Fei Shu , UB 13. If the patient has wind cold, Lie Que, Lu 7 and Da Zhui, Du 14; for wind heat, Qu Chi, LI 11 and Da Zhui, Du 14.

2.      Combined Fei Shu, UB 13 with Zu Sanli St36 and Feng Long, St 40, you may greatly improve your patient’s immune function.

The above patient was diagnosed to have wind cold so after the treatment for about one week and her symptoms disappeared and she returned to work.