Chapter 1 Calm the mind and body

"Pain is a submodality of somatic sensation. The word "pain" is used to describe a wide range of unpleasant sensory and emotional experiences associated with actual or potential tissue damage. "   

    from     http://neuroscience.uth.tmc.edu/s2/chapter06.html

       It is an ironic situation that we lead ourselves into. We created a living structure to provide us comfortable, rich, convenient life. Yet in order to maintain such life, we have to find a good paying job, cope with less than desirable working environment, stressed about the tasks that need be accomplished, deadline to meet, daily chores that can’t be neglected. Everything we depends on , the house,  the cars, the vacation, the stereo, TV , health insurance, student loans, that is “needed for this comfort in life” get us over extended, stressed, unable to relax. Such environment, if not handled properly, can’t be good for our health. It leads to all kind of disorder in our health.

Invariably, stress itself complicates the nature of sickness. The complication comes from mind and body interaction- stressed in the mind and tension in the body. Then. people would spend long hours on the internet searching from the e-universe for the answer. All they got is confusion about his or her physical problems. Or maybe they got so alarmed and discouraged for the projected outcome for their conditions. All of these adds more weight on their already problematic mind and body.

It is easy for our mind to be distorted in a stressful condition. When a person is in lost desert ocean, their physical bodies were extremely stressed and they start to see things. NPR recently did a piece of documentary on body and mind which is quite fascinating. Like pilots under high G force will see themselves flying the jet along with them.

To the extent that is possible, these issues must be addressed at the very beginning of any therapy visit. It helps the healing process.  In addition to address the emotional stress with consoling, there are several acupuncture points that are very helpful as well. Among the most common points are He Gu, LI 4 and Tai Chung, Lv 3.  Most

Many acupuncturists would needle all these four points simultaneously; I prefer to just use two, one each across from each other.  In acupuncture, it is not just which point to use, it is also important to know how to handle the needles.

He Gu is such an amazing point; it addresses almost all of the physical disorder that has certain link to mental issues-concern, angry, worry or stress.

A new variation that gets popular recently is the combination of two points around He Gu. This combo is being promoted by late Master Tung’s disciples. They are Ling Gu” magical valley” and Da Bai or  “great white”. The function is much the same as He Gu but the intensity of treatment is greater. This can be very beneficial but can be overpowering at times. Many well known acupuncturists in U.S. are his students.

Point He Gu is so valuable that it deserves close attention. Most people associated it with relieving headache. It is true. But it does lots more. A lady in her late 40’s has strange problem that her eyes become blurry as soon as she steps into a closed room. One needle on the He Gu and the problem was resolved.

A patient called me from the hospital because her daughter was about to undergo colonoscopy but could not get the medicine down to cleanse the intestine. She kept throwing up. I went to the hospital and gave her acupuncture using just this one point, He Gu. In a few minutes, the vomit stopped and she had no problem of medication. It is very powerful in many patients with acute upset stomach as well. Problem goes away in a few seconds after needle insertion. That is how fast acupuncture can work.

One caution, this point should never be used for women in early pregnancy. In TCM, He Gu acts to regulate the Qi. By regulation, it implies that it will subdue the overactive Qi when needed while boosting Qi at the area of body that has a lack of QI. It rectify the Qi in places where Qi is not doing it is right thing. For example, when the patient is throwing up, the Qi that allows the Food item to descend is not functioning. By using the He Gu, the descending function resumes and the problem get resolved. In early pregnancy, presumably the body still regard the fetus as some foreign invader and will regulate it from developing.

One pregnant woman was overdue for two weeks became concerned because no sigh of labor. I use He Gu plus Sp 6, San Yin Jiao on her and let her go home. She got labor that evening and had a healthy delivery afterward. These practice were recorded over thousands of years.

Alternatively, to reduce the stress, some patent Chinese herbal formula can be used; they can be taken on daily basis for a while. One such formula is called Xiao Yao Wan. Sometimes it is referred as relax pill. This formula has nothing in common as the muscle relaxer in Western medicine, which is actually a moderate neurotoxin. It does not contain anything to sedate the brain either. But it works wonderfully well for lots of stressful people.

The other situation where mind issue must be addressed is with patients who went through horrifying events such as unfolding of an auto accident. The horror can scar the mind and need be resolved along with the bodily injury. This can be achieved by needling PC 6, Nei Guan, meaning “inner gate”. Other mind calming points can also be used as well. The link between the body and the mind is so intimate that often it is not easy to know which one is the culprit. It is interesting to note that by now most people use Nei Guan for vomiting. Including many gynecologists. Together with ginger soup, these two are becoming standard choice for early pregnancy nausea and vomiting. Important to note that the He Gu, good as it is for stomach upset, should never be used at this stage of pregnancy.

In our society, substance addiction together with stress is very common concern. In the eighties, a group of acupuncturists developed a protocol for treating addiction issues through inserting of needles on the ears. It is now called NADA protocol. This Protocol is also very helpful in providing relaxation for people under stress. Acupuncture volunteer often travel to areas of nature disasters and help victims and other volunteers with such treatments. It has good track record of success.

Chapter 2

Wang’s Neck and shoulder treatment method

This topic is divided into several sections;, the neck and the trapezium problems as one, the shoulder joints  and other related issues as the other. The former is very common, with young and old population. The later happens to mostly people in their upper 40’sand older. Younger people only get it through traumatic incidents, such as a bad fall. It will be discussed later the frozen shoulder sections.

Frequently, patients may come in for various complaints such as migraine, dizziness, but not neck and shoulder or simply mild neck issues. These patients would however show various degree of stiff neck. This happens with lots of elderly, some of them may have a significant reduction of range of neck. They may not even aware that they have the problem. It kind of creeping up gradually on them, little by little until most range of movement is lost in the end. After treatment, they would notice that no more need to turn the shoulder to look for the incoming car while driving. They just turn their neck!!

For younger people, it can be a postural issue or traumatic injury. These days, everybody seems to be perpetually sitting in front of computer terminals. Stiff and sore neck issues are common. It makes people uncomfortable, for most people, some rest and everything is O.K. Without resolving the issue, often it leads to other more serious problems such as numbness of arm and fingers.  Sometimes even turn to problems like carpel tunnel syndrome, which is horrible to live with.

2.1      N-S protocol: protocol for neck and shoulder problems

         Basic: Luo Zhen and SJ 10     bilateraly

                   He Gu, Lv 3, one each , diagonal      

The basic acupuncture treatment for neck and shoulder problems is two sets of acupuncture points: Luo Zhen (which does not belong to any of the twelve meridians) is located on the dorsal of the hand, between the second and third knuckles. Luo Zhen means “fell off pillow” in Chinese. It treats locked neck from bad head posture in sleeping. The other SJ 10, which is at the upper edge of the elbow bone. SJ 10 is a pivotal point in San Jiao (SJ) meridian that travels up the arm, shoulder neck, and surround the ears.

For lots of cases, these points work like magic. You can literally see the neck starting to move like been lubricated right after needle insertion. I have taught all of my students of such application. The feedback has been very good.  Sometimes, the effect is not very apparent. Frequently, it is caused by improper needling technique. Not enough of Qi was moved.

When the case is more complicated as in auto related injury, such protocol might not be sufficient to resolve the whole problem. It is important to seek out what the complicating issues are.

2.2       In an auto accident, people most commonly suffer the whip lash. Their heads are thrashed forward and suddenly pulled backward like the tip of a whip during whipping. In many accidents, more than whip lash injury can happen. Strained torso, impacted chest, twisted low back do happen. Sometimes, the head inside the skull can be injured physically as well.

Head trauma is very serious. Peculiar thing happens after some accident.  Often the victims may have been shaken up violently during the accident, but are not aware of much pain. They would be rushed to the hospital, underwent a battery of exam including x-ray, MRI  They are pronounced as healthy and quickly released from the hospital with clean bill of health. This is totally inappropriate diagnosis but happen all the time.

The diagnosis is based on the status of victims in shock.  There is a disconnection between the mind and the body under such situation. After a while, the sign of injury starts to show up, pain also starts to increase and gets more and more severe with time.

In any case, some victims probably would go through a month or two of physical therapy and then will be taken off the insurance company’s list. Some do recover nicely, many do not. Many people would feel certain improvement but not completely pain free.  Furthermore, lingering pain continued, frequently intensified much later. It becomes  difficult  to relate to the accident. This is not a good thing from legal perspective.

For this reason, I routinely inquire about the history of auto accident when a new patient comes in.  I would also ask history of any other traumatic events. Not surprisingly, very frequently, way too many patients would have been involved in auto accidents. Some even have multiple auto accidents. The accidents could be just a few weeks earlier.  For many, incidents actually happened long time ago, like years.  

Auto accident is sad consequence of our modern society. For some people, lives are changed forever with perpetual health issues. For some of these people, they are not aware of their health issues were related to earlier auto accidents.

For a simple rear ended collision, the neck could be shaken quickly, violently. The cervical spine suffered front and back jerking. So, the treatment is to resolve the injury sustained from that. Frequently, the N-S acupuncture protocols works quite well and would be quite sufficient. For a more severe situation, several additional acupuncture points may be needed as well.

These points include Bai Hui, or Du 20. This point belongs to Du meridian and addresses the spine disorder.  The Ren 24, Cheng Jiang for cervical spine which is on the Ren meridian, used because of Yin and Yang coupling relationship. It released the pain and stiffness at the T-1 of spine. Frequently, SI 3, Hou Xi is needed because they are the Lou point of Du meridian. It addresses the pain along the spine. If the pain is at the occipital, then UB 65(Shu Gu)  has to be needled, on the same side as pain. This point can be used for lots of other problems but is a sensitive spot that I don’t like to use it unless necessary.

Evaluate the progress after needling each point. I like to ask the patient to turn the neck from side to side to see the progress. It was found that the therapeutic result gets a boost if the patients exercise the painful area while needles are in.

The result should be quite impressive, regardless of the duration of the injury. In addition to moving the stagnated Qi, I suspect that is also because of resetting of neurological memory( so called muscle memory).

As mentioned above, the mode of automobile injury can be complex. Therefore, if the above N-S treatment method only brings about some degree of pain relieve. It would suggest that other parts of body are significantly injured as well. Two likely scenarios are the twisted torso during the collision or pulled chest muscle caused by restraining safety belt. Under these circumstances, certain areas on the chest near the shoulder joint, under the clavicles, the flank of the body can be sore to the touch. Needle painful area, or better yet, apply indirect moxibustion over the painful spots generously. The pain in the neck would show relieve immediately.

 A female patient had a complaint of tight shoulder. Sometimes it would be so tight that it became painful and head would hurt. I asked her to turn head from side to side. It was apparent that her right shoulder was very tight. The right upper trapezius muscle was tender to the palpating pressure. Bending the neck caused the achiness at the occipital area.

 I inserted needles at the regular places- Luo Zhen, SJ10. The improvement was moderate.  I then added SI 3,  Ren 24, Cheng Jiang and Tiao Kou, St 38 on the right. The pain was further reduced but still not completely gone.  This implied that it was a more complex case with multiple sources of problems. I palpated her left infra clavicle area. Both distal and proximal ends of sub clavicle exhibited sensitive to palpation. I used indirect moxibustion on these areas until she felt too hot. Immediately, the tightness of the shoulder disappeared. Her comment was that she never aware that the left chest is so sensitive to touch.

A 62 year old female patient who was injured in an auto accident. Front and rear of the car on the driver side were smashed. The car was totaled by the insurance company. The above mentioned treatment was successful. However, in addition to the pain mentioned above, a few weeks after the accidents, her right head started to hurt so was her left eye. She felt constant pressure on the left eye. She was examined and referred to glaucoma specialist. She was told to be a good candidate for laser treatment of glaucoma. This was strange as glaucoma usually takes a while to develop. I used indirect moxibustion over her forehead, her left temporal area and area up to one inch inside the hairline on the left side. After three sessions, the eye pressure disappeared, so was the headache. A couple follow-up treatments and the problem seemed gone.  She continued for treatment for about three months for other injury.

Moxibustion on and over the head /face needed to be conducted with extreme care.  Historically, acupuncturists try to stay away from such practice as much as possible. However, I found it is very powerful and useful. I achieved lots good results that are hard to get with other modality. But, great care has to be exercised to prevent patients from burn injury due to the debris of moxibustion stick. Do protect all the eyes thoroughly. Otherwise, don’t do it.

Cervical disc herniation

Herniated disc syndrome refers to the protruded disc from the spinal column. It can happen in the cervical area between C-5 to C-7 or the low back between L3-l5. These areas have unprotected spine and are subjected to majority of motion. Other places also could have it but much rare.

A 40 year old female was struck accidentally to the neck by an object while at work. She was referred to me by a chiropractor friend and an MD when the pain at the neck had spread to the left cheek.

X-ray has shown that her cervical area suffered from a herniated disc injury, “up to 2 mm broad based posterior disc protrusion at the C5-C6” and “up to 5 mm left posterior-central disc protrusion severely compressing the adjacent sac and moderately compressing the left margin of the spinal cord which is displaced posteriorly at the C6-C7 .” according to the radiology report.   Her neck’s range of motion from side to side is only about 45 degree.

The acupuncture treatment was performed followed N-S protocol, plus a few additional points. The pain immediately reduced. After 12 weekly visits, she had a complete range of motion, no pain at the neck or facial area. Interestingly, x-ray continues to show some disc herniation at the C6-C7. Years later, the patient still showed no problem on the neck.        

What is meant by “Cure” of herniation of discs?

            Such incident brought about a question about concept  of “ cure”. The fact about herniated disc problem is that the presence of herniation does not necessary causes significant health problem. People can have herniated disc yet walking around without any discomfort. Clearly, herniation of disc does create potential physical interference to the nerve. The good posture would therefore be preferred for the optimum health. More important, with good posture, the reversal of herniation is possible.

Chapter 3        Complications, part 1

3.1 Migraine and other headaches

Migraine can be very devastating to the life of the sufferer. It is unpleasant for some but can be incapacitating for others. As we understand now, it is a consequence of vascular disorder. More precisely, it is the expansion of arterioles on the side of the head. As such, events which causes alteration of blood flows to the head could affect the migraine episode. Among them is the menstrual events which tend to cause the emotional fluctuation, loss of blood and the body’s response to all these events. It is no wonder female migraine sufferer outnumbers male by a large number.

Pathologically, as capillaries expand on the temporal area of the head, they pressurize the adjacent nerve receptors and hence trigger the headache. The root cause is that the tissues in these area demand more blood flow. Unfortunately, as with other bodily event, the pain actually triggers musculature of the area. It triggers the head and the neck to tense up which further reduce the blood flow into the head.  

Therefore, our modern medicine of treating the migraine has been to constrict the arterioles to reduce the pressure to the nerve. It works in reducing pain for as long as the medicine remains potent. On the other hand, the true culprit, the demand of more blood flow is not been resolved setting up for the next episode of migraine.

3.1.1    A 55 year old female, artist complained having severe headache for over 20 years. It happened every day. She had not had a restful night all these years.  It showed on her face and work, excessive aging. She also complained about tight neck muscle and some low back issues, she attributed that to the moving her big art works.

            She also had the hot flush disturbing sleeping at night for two years. She couldn’t take medicine because that would trigger her asthma attack.

Naturally, her neck and upper trap were tight to touch. It felt like pressing on wood board. It turned out that she was attacked once by an intruder. She was choked from behind and that she was so certain that she would die. Years past, she still remembered the incident vividly.

I treated her with the above protocols for neck and shoulder. Within a few weeks, the headache was reduced to twice a week. A few months later, the headache had stopped all together.  The tightness of neck/shoulder muscle had improved, although not totally disappeared, as unconscious reminder of the attack. The headache never return when checked one year later.

3.1.2    A male patient of 62 years old auto mechanic had debilitating headache, continuously throughout the day and night. This happened after surgery to fuse cervical spine. Before the surgery, he had chronic neck pain due to “wear and tear”.  He worked as auto mechanic.

Surgery scar was about 3 inches long, visible at the front right side of neck above the collar bone. The surgery did not resolve his problem.  Instead, ever since the surgery; he had headache, neck pain, chest tightness, arm pain. He couldn’t raise left arm for more than 45 degree without excruciating pain going down from deltoid to anterior aspect of his arm. His left arm pain was worse than the right. He was taking Celebrex.  The senses of the left fingers were diminishing due to what his doctor diagnosed as atrophic nerve from diabetes. For which the doctor prescribed Neurontin (This is kind of odd prescription, as Neurontin diminishes nerve activity to suppress pain sensation.).

Acupuncture brought him a lot of relieve. Following the same procedure of releasing the neck shoulder and occipital explained above.  Unfortunately, the worker’s comp was very biased against acupuncture. He had very hard time to get continued acupuncture. Overall, he was able to get 12 visits over two year’s time. That was considered as lucky. He still had headache although at a much less intense level.  It would gradually become worse and needed be treated pay from own pocket. He is still trying to get the insurance company to authorize more acupuncture.   

More on Headache

Headache is a very common problem. It is annoying at the least. In serious situation, it is quite debilitating, as is frequently the case with migraine sufferers. The presenting symptoms vary a lot: heaviness of head, foggy head, pins and needles, knifing sensations, pressure, and vise gripping at the side of the head.

            The most important issue in treating headache is accuracy of diagnosis. It dictates the effectiveness.   Because the head is always exposed to the outside world, it is subjected to the impact of environmental factors.  For instance, without proper head protection in the extreme cold, head would be hurting.  When sinus problem is triggered by the weather and acts up, headache ensures.  Situations like these are easy to diagnose and easier to resolve. When headache persist, people become dreadful of brain tumor.  Fortunately, that instance is rare and can easily rule out by modern imaging technique.  In addition, the pain is usually unrelenting that does not vary much throughout day and night. There are also likely to have other unusual neurological events as well, such as pain or strange sensation in other parts of body that is difficult to diagnose. On the other hand, most brain tumors do not cause headache.

A 30-year old female employed at a cosmetic company had a strange complaint. For many years, she had this headache which was located deep behind her left eye. The pain usually got worse in the afternoon. Medication was not able to help her relieve the problem. Other than the pain, she appeared healthy and energetic.

Upon questioning, she recalled an accident she had as a child where she sustained a head injury that required suturing of the scalp about two inches above the lateral edge of the left eyebrow. The doctor had assured her that the injury had completely healed. Hidden under the hair, the scar could be felt from the suturing.

The best way of removing blood stasis at the body surface is using moxibustion together with electro acupuncture. After three visits, her headache disappeared.

Head injury can cause headache in the later years.  In 1999, I had this beautiful female patient in her 30s came in for acupuncture. She came with a small baby in baby carriage. She did modeling in Europe before moving to the United States. Everything was great for her except she had this bad headache that just would not go away for many years. No medical doctor could find anything that leads to her condition. No medical treatment was able to solve it. 

It turned out that on her head there was a quarter size spot that was painful to pressure.

This is indeed an interesting case. In TCM, it is well known that in numerous situations, pain is caused by blood stagnation. Such stagnation can be resolved by bleeding. This is accomplished by acupuncture needles or a special needle that has three edged tip. Mostly, only a small drop of blood is let out. In a severe situation, it is coupled with a procedure called cupping where a suction cup was applied to the needled spot to facilitate the bleeding of the stagnated blood. This is rarely done in U.S. as we are very sensitive about blood spill in this country.

Bleeding is not uniquely TCM. It was the main stay of medical treatment in Western world such as France and America in the 17^th century. In that good old times, whenever people had a fever or distention of the head( possibly high blood pressure), they would go to their favorite barber shop and had some blood drained. Barbers at the time was competing with surgeons for business and winning. George Washington, founding father of U.S.A. had a fever and was treated by bleeding. Unfortunately, he died the day after the treatment.

Instead of doing blood letting, I did moxibustion on her head for a few minutes. The pain subsided and the headache was gone.

As with the diversity of symptoms for headache, there is diversity of causes. The list includes stress from physical and emotional, traumatic injury, vascular excess or deficiency.  Since pain sensation is a neurological event, it is no surprise that nerves are always involved, so is the mind/ emotion of the patients. As long as the source of the problem remains unresolved, pain will continue.

SO, it is important to know the history or progress of the disease. For instance, if the person has neck and shoulder pain first and then the headache started to show up, then it is most likely the headache is the consequence of neck problem. The first line of treatment is to resolve the neck issue with minor focus of symptomatic treatment of the headache. Neglect the neck problem, the headache will never disappear

Headache with high blood pressure

High blood pressure would cause headache. In TCM, this is called Liver Yang rising. With severe cases, Yang rising can trigger Liver Wind and patient will experience dizziness. It could result in Wind Stroke and the person becomes unconscious. In modern terms, this is called stroke due to bleeding in the brain. As we age, our capillaries become stiff, less elastic and break easier under high pressure.

A family friend is a Philippine lady in her early 60s. With stressed life and rich Philippine food, she developed high blood pressure. Naturally, she is on med. The headache would frequently occur and it would be so debilitating. Following  the acupuncture protocol above for the neck and shoulder, adding Lv 3 for liver and Tai Yang for temporal tension, her headache would subside. Life would then be better for a while.        

A strange case of headache

A female student in her late 40s had this weird headache for as long as she can remember. The pain is located at the top of the head, about 2 inches radius. She always had hot sensation at this area. She could not recall how it could have happened. She also had the problem of eyes that became blurry walking into a closed space.  

I did indirect moxibustion on her head for about 5 minutes.  She felt warm and comfortable with heating.  She felt the pain was reduced somewhat.  However, after overnight, she started to feel uncomfortable at the whole head. That discomfort lasted for five days, and then in the morning, her eyes started twitching. After the dinner, her right eye felt tension.  At about 10:30pm her son asked her what happened to her right eye as the lateral half of her right eye appeared blood shot. All she can recall was that she felt something pop inside the skin at the temporal area before this happened.

The funny thing is that her 40 some year’s headache had disappeared. Strangely, the “heat” sensation at the top of the head was also disappeared.

The red eye was caused by internal capillary bleeding in the right eye. Certain capillary inside temporal area supplying for her right eye was leaking.  She went to family doctor and was told that indeed there was capillary leakage and it was not serious although it looked awful.

Apparently, this lady had a long standing blood stagnation issue that caused for her lifelong headache. As is frequently the case, the blood stagnation turned to heat as body tried to resolve the problem (modern language:  inflammation, which caused headache). With my moxibustion, the body was able to revive the stagnated blood and found an outlet and resolved the issue. Since I did not do bleeding, her body found its outlet which lead to the right eye.

I saw her the day after the red eye happened; I applied indirect moxa around her eyes (never moxa over the eyes) and told her to do it at home. She also had fellow students did acupuncture work around GB 1.  In a week, most of the redness has disappeared. The headache never comes back.

By week three, the redness in the eye was almost gone but now her complaint was about tension around the right eye. The tension was made better with indirect moxa, needling at UB 1 and Tai Yang. Later on, I found that she had LASIX surgery to correct her vision which had been causing her tension around the right eye and perpetual dry eyes. So the tension around her eyes might not be related to the treating of her headache.

3.2       Ringing in the ear

Ringing in the ear is very annoying. For severe sufferer, it is devastating. One patient was sent in by his wife because he had “missed lots of conversation” according to his wife. He knew he had ringing problem but was not aware the hearing issue.

The incident of ringing increases with age. Older people frequently have it. In TCM, it is customary to distinguish ringing problem to the pitches of the noise. Older patients tend to have low pitch noise while younger patients would have high pitch. My experience is that regardless of the age, the noise sensation is mostly caused by the excessive muscle tension around the ears, particularly, the TMJ muscle. Therefore, most of the time, people with ringing in the ear would have tender and tight muscle groups surrounding the ear. The acupoint below the ear lobe, SJ 17, would be tender to pressure for them.

As the result, any treatment that would help relax the tension of these associated muscles and get the Qi moving would also be beneficial to reduce the noise.

Therefore, the starting point (no pun intended) is to relax the neck and shoulder tension using the above protocol, followed by needling of SJ 17. Because the GB meridians  also go through the ears, it is helpful to needle the GB meridian at some distal points such as GB 39. Additional benefit would result by warming the area around the affected ear(s) using a heat lamp.  Apply Moxa stick indirectly on the tense area surround the ear is extremely helpful.  Because LI 4 is very effective in regulating the Qi, It should be included as well.

With these points in place, patient will literally feel the noise level decreases. For most patients, such problems have been with them for a long while. Their neck and shoulder muscles tend be always tense. It is expected to have more than a couple treatments to change such situation. The result can be further enhanced during treatment by having the patient taking a few very deep breathe during treatment.

 The treatment would be more difficult if the patient had been treated surgically that aimed to” correct the inner ear defect”. I have a male patient who had this problem for a long while; he also had many procedures done to the inner ear, including surgical drainage, to no avail.  These procedures created additional problems like scar tissues, deceases the flexibility of the ear musculature (similar to situation with elderly patients.). The treatment then has to rely heavily on moxibustion as well as electro acupuncture. It was effective as well. Moxibustion is not very easy to undertake here but is essential in this situation.

Another interesting case happened to me in school’s clinic. A female student in her early 30’s had chronic “wave noise” issue in her left ear. She was trim, tall, big eyes of Indian decent. Unfortunate for her, such issue had been with her since her childhood. Initially I used the above protocol to treat her ringing, believing it should be sufficient. To my surprise, the ringing only subsided partially.  Then I started palpating her temporal area surrounding her ear. I discovered that she had a tender spot directly above her left ear. She never complained about that.  Turned out that as a child she had an accident and sustained an injury of head above the ear.  I applied indirect moxa over the tender area a few minutes, once each week for three weeks. The tenderness disappeared. The noise also disappeared as well. It was a strange feeling for her not having ringing in the ear.           

3.3       Dizziness

There are mainly two types of dizziness based on the mechanism of the problem. One is the lack of blood/oxygen to the brain. In the severe case, a person can pass out.  There are myriad of causes that lead to such blood deficiency, such as clotting of certain artery to the brain, blood vessel spasm, insufficient of blood circulation to the head. One common phenomenon that causes under such category is orthostatic hypotension. Whenever we change our posture like standing up from lying down, our body has to raise the blood pressure quickly to maintain proper blood pressure in the head to avoid transitory low blood supply in the head. Such reflex mechanism tends to weaken with age and for some elderly, it becomes a troubling issue. It can leads to a bad fall. For the same reason, many people fell light headed after acupuncture because the body becomes so relaxed that orthostatic low blood pressure kicks in.

The other type of dizziness comes from disorder in the inner ear. Our inner ear has sensors that give the information to our brain about our body’s balance. These sensors can be disturbed and we would lose sense of balance. It can also make us feel like the world around us is spinning.  This could also easily cause the reflex reaction in the stomach and induces nausea. Doctors commonly blame it on the excess fluid in the inner ear and call the symptom Meniere's disease. So the medical approach is to reduce the amount of fluid by draining fluid from the body trough medication, or try to surgically drain the fluid. Surgery has the potential of causing harm to the hearing organ.

           In Chinese herbal medicine, there is a formula called True Warrior decoction (Zhen Wu Tang) that is very effective to drain excess fluid in the body. This formula can be effective in treating such problem. Better result can be achieved by combination of acupuncture and moxibustion. The theory behind it is that provided the inner ear structure is not damaged, the fluid excess is merely a Qi stagnation phenomenon.  Such stagnation stops normal drainage of the fluid and leads to fluid accumulation. As the result, sensory function of the inner ear becomes disorderly. Once the Qi is restored, the fluid draining function in the inner ear return normal and dizziness goes away.

There are a few meridians surround the ear- the gall Bladder, the San Jiao and the small intestine. All of these meridians can be involved. The situation is very much like the issue with tinnitus.  The treatment for this disorder is the same as ringing in the ear. This is called treating different disease with same method. For Qi perspective, both diseases have similar disorder- Qi stagnation in the inner ear.

            If the inner ear is damaged from prior infection or traumatic encounter such as injury or surgery.  It would be more difficult to treat as the situation involves more than just Qi stagnation.  Simple Qi restoration through AcuMoxa a few times would not be sufficient .

3.4       TMJ

TMJ is one of the problems that are most suitable for acupuncture and moxibustion. It could be caused by toothache, tension, stress or injury resulted in inflammation at the joint. The muscles surrounding the Junction become exceedingly tight. The protocol for neck and shoulder (N-K protocol)is the first step for treatment, followed by Moxibustion and electro acupuncture at the St 6 and SJ 17. At times, the temporal area may be very tender and Tai Yang (extra point) has to be needled obliquely.

This procedure helped a 38-year old lady with pain resulting from dental work on her molars two days earlier. The day after her dental procedure, opening the mouth caused excruciating pain. She was not able to open her mouth more than 2 cm wide. She phoned the dentist and was referred to an oral surgeon. Instead, she came to my office, two acupuncture visits later and the problem was completely resolved.  The dentist was very happy to pay her acupuncture bill. Turns out, such incidents from dental work happen common enough, apparently many dentists are not very tending to their patients suffering.

Such incidents are acute problems. A few acupuncture treatments are all is needed. For chronic sufferer of TMJ, more acupuncture visits will definitely be required. Many people would have an emotional component as well.

3.5       Grinding teeth

This is a frequent patient complaint, often told by their dentists or hygienist.  The standard practice is to wear mouth guard to” prevent” excessive teeth wearing. Most people have no idea what it is about. Some people however do have issue with tight jaw.

A 50-year old executive had a complaint of grinding of the teeth. Although he was not overtly complaint about the neck and shoulder region, palpation revealed that these areas were very tense. As a result, excessive tension was created in the temporal and masseter muscles near the temporomandibular joint (TMJ). Therefore, the 1^st thing to do is to treat the neck and shoulder following the N-S protocol and then add SJ17 and St 6. Adding electro acupuncture and moxibustion enhances result. Many people who have this issue tend to be under lots of mental stress and therefore it is important to address this issue as well. Different people carry the stress on different part of their bodies.

3.6       Toothache and other dental problems

Toothache is one reason people pay visit to dentists. This is especially true in the old days before the cosmetic dentistry exists. However, it should be clear that most toothache is not related to dental work. I do think acupuncturist can do better job of relieving patients toothache if the acupuncturist knows how to treat such problem. At the least, it is minimum invasive. No harm is done to the tooth.

The key is the knowledge.  Most of the time, the tooth pain is related to Qi congestion at the junctions between the upper and lower jaw. It is not the individual tooth that is causing the pain even it appears so. “When Qi is congested, it will be painful”, as is frequently repeated in Traditional Chinese medicine.

Examine the cheek with fingers.  First, opening mouth wide, press at the spots a few fingers width in front of the ear lobes. You can feel spots open between bones.  When these two spots become tender to pressure, you are in trouble.

Massage with thumbs on and around the tender spots will help the tension.  Warm up the spots are very beneficial.  Another way of reducing the pain is to stick index fingers inside the mouth and massage the junction between the upper and lower jaw. It should feel sore and nice. Close the mouth or bite down the teeth while the finger is still in for a few times(watch out for finger.). As you do these things, you would notice that the tooth pain decreases. 

The interesting thing is that it may appear that the pain originates from certain individual tooth, but to release the pain, you should focus on the jaw junctions, not the individual tooth.  For acupuncture treatment, because these areas are where Stomach meridian populate, needling the foot Stomach meridian would be very beneficial, such as St 41, St 44 in addition to St 7 on the cheek.

This procedure does not work very well if the pain is caused by ulceration of the lining or infection of the gum. Gum infection needs to treated, preferably with antibiotics locally. Pus from infection, if any, should be drained to speed up recovery.

3.7       Trigeminal neuralgia

            This is a type of facial pain that appears along one or more of the three branches of trigeminal nerve.  As with other nerve pain, moxibustion is the best way to speed the recovery. One of the hallmarks of this pain is that there can be a spot too painful to be touched. Needling should be paced around this location. This is a special technique called Yang (meaning: rising) needling.     

4.         Complications part 2

4.1       Upper or lower arm pain

            The pain at the arms can be very disturbing, very painful. The pain is perceived at   certain locations on the arm. Often, it is along the meridian of Large Intestine. Points like LI 10, LI 12, LI14, LI 15 are frequently the most painful. Needle these points or moxa           these points are helpful. However, In most situations, the culprit is the Small Intestine     and San Jiao meridians. Palpating these meridians and very painful spots can be found.   These spots need be addressed. The best way is to moxa these spots until the pain level      is reduced. Stretching the elbow to make sure free movement is also important. Do not           forget to address the neck shoulder as well.

            The spots to Moxa : Ashi, especially near SI 9 on the painful arm and H3, Lu 5 and          LI 10

4.2       Carpel tunnel

Carpel tunnel syndrome is a painful disorder at the wrist. Moving the wrist can send a shocking pain toward the hand. It is caused by long duration hand use; computer keyboard, checkout counters, washing, mopping or any other type of repetitive works with hands.  These activities can overly stress the muscles in the arms and hands. Overtimes, the nerve under the wrist become sensitive, resulting in severe pain.

Standard practice of treatment is based on treating the tendon at the wrist. The general Western medical approach is to fix the tendon-nerve in this area. Injection of pain killing medicine or surgically reduce/remove the wrist tendon are commonly done. Pain killer injection works for a short time. Surgery seems to be an overkill. It also resulted in weakened wrist, which would be permanent. It should be considered as the last resort.

The secret of treating carpel tunnel syndrome lies in treating the source of the problem. They are the upper arm and lower arm.  Very frequently, neck and shoulder are involved as well. Over- used muscles in these areas are the culprit. When these musculatures become problematic, they would be tender and inflexible. The hand motion become difficult and very easily over loaded.

            So the treatment is very similar to treating arm pains. So treat the neck shoulder as previously described, treat the arm by palpating the most painful spots, most often along the SI, small intestine meridian and LI, large intestine meridians. Treat them either with acupuncture or moxibustion. Then, do a little TLC at the hands and wrists, with moxa or massage. The pain will be significantly reduced. A few treatments coupled with physical exercise to strengthen the arms and hands musculs, the problem will be resolved.

4.3       Numbness in the arms and fingers

Whenever sensory nerves are squeezed, it will turn numb. We all have experience of numbing sensation after sitting at the same position for a long time. This is caused by nerves being squeezed. If the squeeze is tight enough, the blood flow would also be stopped. When this happens, the limbs turn cold and pale. This is a common phenomenon called pinched nerve.

SO, the goal is to resolve the squeezing. Most of the time, it is the musculature related events. Such is the case with so called thoracic outlet syndrome which is produced by abnormally tight scalene muscle which runs from cervical spin to the ribs. The solution is to get the muscle to restore its flexibility. Again, first relax the neck and shoulder following the above protocol (N-S protocol). Then, check a few spots for tenderness and treat them accordingly: Lu 1 or 2, St 11, St 12.

-Reynaud’s syndrome

            Some people have this kind of “genetic predisposition “that when their hands are exposed to extreme cold, their fingers will turn icy cold and blue. The best approach is prevention by avoiding exposure of the limbs to extreme cold.

4.4      Rotator cuff pain and frozen shoulder

4.4.1        A 75 year old male called in for treating his rotator cuff problem. He complained about weakness and soreness of his left rotator cuff. Raising up his left arm caused pain. He had to use right hand to comb his hair.

            He was on Levastatin and Prostrate.  He had an appendectomy six years ago. From time to time, his back would “act” up and he would be unable to move the shoulder. Otherwise, he appeared healthy.

            The pain was at the front of left shoulder joint. Although he did not complain about the neck, when I asked him to turn neck from side to side, he could only turn about 30 degree toward either direction. He confessed that he had some neck problem and had gone through physical therapy for a while but it never got anywhere.

            I put a heat lamp over his left shoulder and insert needle following the above N-k protocol. His neck loosened a bit, the range of motion increased to about 50 degree, tighter on the right. He became a little concerned when his triceps on the right arm started to twitch. It was not painful.  I assured him it was alright. Now the pain seemed to shift from shoulder joint to the muscle between the shoulder blades. I inserted needles in Tiao Kou, St 38 at the left lower leg and add Ren 24, Cheng Jiang Midway below the lower lip. The pain subsided.

            To enhance the effect on the shoulder joint, I added LI 12, on Large Intestine meridian, 2 finger width above the elbow on the Large intestine meridian.

            Because he had a chronic backache (though he felt alright at this time.), I added a few needles to address this issue following the protocol for low back pain (refer to Dr. Wang’s method for treating low back). This is part of the philosophical approach  of treating the possible future disease.

            After 35 minutes, the problem totally disappeared. However, this was not a typical of rotator cuff pain. It was a case of overwork of muscle. He tried to cut down a tree a month ago. It was a hard work; He was tired but insisted on finishing the job. The pain started to creep up and he was not able to get rid of it all this time.

4.4.2    A 48 year old female complained about shoulder pain which kept her awake at night. She was diagnosed as having frozen shoulder. The pain started after a surgery a few months ago to fix the broken clavicle from an accident. A steel pin was used to stabilize the clavicle.  She needed to use left hand to assist raising right arm above shoulder level.   She was told that the encapsulation of the joint caused the frozen shoulder. She also had another operation which fused C6-C7.

She appeared healthy, trim.  She had some bad mood frequently. Her neck’s sideway rotation range was restricted somewhat, worse turning toward right. Palpation indicated that her chest under the right clavicle was tender.

Analysis: Encapsulation may be the cause for her inability to raise arm normally. However, since the “frozen shoulder” happened after the surgery, encapsulation was not a long drawn out issue and should be easily reversed. Therefore, this type of frozen shoulder is much easier to treat, in contrast with typical “frozen shoulder” that is due to aging, like most people over 50 who have weakened Qi from aging process. In TCM, this is a Qi problem-Qi is stuck, which did not allow the arm to move. Qi got stuck as the result of surgery.

To move the Qi, points which move the neck /shoulder were used (refer to N-S protocol). In addition, St 38, Tiao Kou on the right leg and SI 6 on the right arm were used. I also applied moxibustion over the upper chest near the shoulder and the area posterior to the shoulder joint below SI 9.

Patient  was amazed at the result. She was able to raise the right arm over the head without the assistance of left hand.

She came in the next week saying that not only she was happy, everybody in the family was also happy because she was not as cranky any more. She had no pain using right arm during the week after the treatment.

She still had minor pain in the upper chest and left neck upon palpation. The chest pain is related to the surgery. It needs time to heal. In TCM, This is a blood stasis issue. Using heating pad or moxibustion over the affected area on daily bases for a period of time is the best remedy for such problem.

Smokeless Moxibustion

Moxibustion is as important acupuncture. As a matter of fact, in Chinese terminology, acupuncture and moxibustion goes together.  Typical Moxibustion uses mugwort stick and produces strong fragrant and thick smoke. It works great for the purpose. Unfortunately, in modern clinic, particularly in US, it is over powering and not practical with central air.

There s a good alternative called smokeless moxa.  Most clinicians do not know like it because they do not use it properly and therefore do not think it is effective. This is not true. Use it properly, it is better than the regular smoking moxa in terms of effectiveness and safety.   

As important as it is, insurance companies no longer pay for moxibustion procedure. They rather pay more acupuncture visits. Or, just allowed for a fix number of acupuncture therapy per year.

4.4 trigger finger

Some people develop such finger issues. They can bend the problematic finger but can’t straighten it back. The finger appears like been locked in position like in rifle shooting.

The culprit is the tendons associated with the finger joint become too tight preventing the bones to slide against each other to extend the finger.

Moxa the surrounding of the joints.  Remember the guiding principle in moxibustion-“Moxa until the patient feel pain”. Pay special attention to painful spots adjacent to the joint. Stretch the affected finger regularly for a period of time. The problem would be improved.

Chapter 5        Low back pain: A big health issue

A good portion of patients came for acupuncture because of low back problems. The problems include common back soreness that people suffer from time to time to pain so severe that patient can’t stand up straight. Statistic indicates that everybody experience back pain some time in their life. Some goes away by itself with proper rest and stretching. Some involves more serious problems like stenosis, herniated discs, sciatica pain, scoliosis that need be treated to get better.

Acupuncture verses other kind of treatments

Back pain is where chiropractors make most of their money and where large sum of money is spent in this country in the treatment.  A big portion of that sum was spent on surgery, in spite of study findings that challenge the effectiveness of certain surgery. Few people know TCM is incredibly effective in treating the back problems. The results are often “miraculous” according to patients. It has not been properly recognized because of variety of reasons. Among them is the inability for obtaining consistent results for some practitioners. The truth is, treating it properly; the result is very satisfactory.

In general, people who have suffered the disorder for a long time or have had surgery would have a great improvement initially. Then, progress will be gradual as the body needs time to repair the damage.

For the long term goal, acupuncture, heat therapy plus strengthening exercise offer the best outcome. This strategy provides the ideal environment toward eventual healing of back problems.  

5.1 Why does the low back have so much trouble?

To understand the problem facing us, we have to look at the anatomical structure of the low back first. All of the physical work of the back requires( to be exact, any movement) the involvement of low back- L3, L4 and L5 and the musculatures associated with them.  Of 17 segments of lumbar and thoracic spines, only L3, L4 are allowed to have free rotation. Such ability subjects them to the brunt of any stress- from work, sport and its related injury. With age, the strength of the musculatures and the tissues supporting the discs begin to deteriorate, making it even prone to become overuse. Equally important issue is the uneven use of the muscle groups which results unbalanced  muscle tones in the back. This is particularly true with many sports activities. These misuse, eventually leads to back pain. On top of these issues, many of the intervention, including the back surgery often leads to weakened and injured back. It is not uncommon to see patients whose surgeries to “correct” the back problem made them worse off.

How does TCM diagnose back pain?

TCM in the modern times often attributes the low back pain to either Kidney disorder or Bi syndrome provided the issues was not caused by traumatic injury.  Therefore, TCM doctors frequently prescribe formulas base on the Du Huo Ji Sheng Tang for the low back pain. Because such formula addresses these two issues. This approach with some variation has been common among TCM practitioner for thousands of years. The result is often slow.

However, according to Yellow Emperor Inner Cannon( Huang Di Nei Jing) which was written more than 2000 years ago,  Kidney Qi should not be a major cause of back pain for most people except for geriatric population. In other words, Kidney Qi and Jing should not be a common problem with people below 40 years old.  Yet most patients complaining back problems are under 40s, some are in their 30’s even 20’s. How would prescription formula based on this approach be able to address the problem? It can’t. Even if it does at all, it will take a long time to see the result. Our patients can’t wait that long and should not.

TCM treatment of low back Pain

            T CM treatment of low back pain includes herbal decoction, acupuncture and      moxibustion, Tui Na, Cupping , external liniment application. Historically, Tui Na has      been the most common approach for back pain. It is quite effective in cases such as disc             herniation, fusion of muscle tissues, scar formation or mis-alignment of the joints.       Effectiveness of Tui Na largely depends on the skill of the practitioner. It is similar to        chiropractic manipulation in many way with the exception of it also addresses muscles     and tendons issues, not just alignment of bones, much like the combination of          chiropractic adjustment plus massage. Liniment is good for acute situation. Cupping is not very commonly used for low back issues.

5.2 Wang’s Low back treatment

In truth, the best approach is based on the mix of acupuncture and moxibustion. Indeed, according to Nei Jing, acupuncture is the quickest way to treat disease with result. Interestingly, Nei Jing also said that acupuncture is very easy to apply but difficult to be good at. The key components in success are point selection and the mastering the Qi with needles. In any treatment, when the proper Qi arrives at the diseased location, the treatment will be effective. This is easy saying than achieving. To get the QI to the diseased location is very easy, to get to Qi properly is much more difficult.

Most common, acupuncturist will use Ashi points to treat the low back by palpating the most painful location(s) and insert needles on them. This is based on the principle that “the painful point is the Shu point of choice”. Because these spots are painful, there is always strong Qi elicited with needling. There is no question that Qi was obtained with needle insertion. Unfortunately, this Qi may or may not be proper.

Alternatively, another common practice is to seek Wei Zhong  for back pain treatment. This was promoted much later after Nei Jing’s publication. It became “the rule of thumb” for low back pain.  This is not the original intent of Nei Jing. Wei Zhong itself is not always the right choice. More accurately, it is necessary to search the entire popliteal fossa to find best point to address the low back pain. The points of importance include such points as UB 39, UB40, LV 7, LV 8, sometimes even GB 34.

In clinic setting, I found my approach of diagnosing by the location of pain and treated accordingly to the spirit of Nei Jing seems to work very well. It is more targeted and easy to apply in dealing with back pain of various origins.

This approach involves dividing the low back in several anatomical zones and selects the pts according to the zone involved.

Zone 1, on the spine

Zone 2, along the side of spine

Zone 3, on the inner line of UB on the back

Zone 4, on the 2^nd line of UB on the back

Zone 5, on the hip over the gluteus

Zone 6, on the hip over the greater trochanter.

In treatment, the first step is to identify the pain location by asking patient to twist or shake the back gently. This allows the patient to identify the specific location of the pain.  Then confirm the diagnosis by palpation the location.

Once confirmed the local of the pain, apply needles according to the following rules:

Protocol L-B:

Zone 1, Du 20 and Ren 22

Zone 2, SI 3, the Luo of Du Channel

Zone 3, SJ 4, or Yao Tong Xue

Zone 4, GB 42,

Zone 5, Gb34, Yang Ling Quan

Zone 6,  use Lv 7 and Lv8 .These two points are also very good for general back pain because it is related to sinew. Sinew plays a big role in the pain process. The other reason to use these two points is that liver is the paired organ for Gall Bladder, thus it address many problem in the gall bladder meridian.

Always choose the same side as the pain. If the pain does not completely dissipate, then try Wei Zhong (UB 40).

5.3 Most important requirement of needling technique

The most important requirements for effective acupuncture needling is to get hold of Qi (In TCM, it is called De Qi, or obtained Qi. More precisely, obtaining the proper QI). There are many indicators of De Qi but none is for sure. My way of obtaining assurance is tapping the needle while having the patient stretch the back. Patients often will find that pain seems to dissolve with such stretching reflecting the moving of Qi.  At other times, patients might notice that the location of the pain seems to migrate. The truth is not that pain has moved. Rather, these patients have had numerous painful spots than he or she recognized. As the most intense painful spots got resolved, the secondary pain become dominate and thus the feeling of “moving pain”.  Then the focus of treatment needs be changed as well.

Notice that such approach requires the patients to lie down on their back, supine posture. Often some patients are very skeptical at first. Some reassurance may be needed. Once they experience the result, they most likely will turn to true believer of the acupuncture.

One navy vet who just retired because of messed back and knee had a very painful back, difficult walking was brought in by his girl friend. He was in his 50’s endured through three helicopter crashes and remarkably survived. After the treatment, he felt very good, able to go dancing. He told me afterward that he was very skeptical at first because I had him lying on his back without having any needle on his back but just had him moving his low back, But then he started to feel that the pain disappearing. He started to smile.

Also this approach is totally applicable to the problems that are referred as disc herniation or stenosis of the spine, even the sciatica.  For these issues, there are many zones affected. Following the zone diagnosis and select the appropriate pts and needle them. The result should be very impressive. More on this later.

5.4   Strained and /or sprained low back muscles

            This protocol is very effective on these issues, be it acute or chronic. Sometimes, patient’s problem involves the whole body, as in fibromyalgia condition. The neck and shoulder has to be treated as well following N-S protocol.  The results are quite good. However, these conditions exhausted the body and the patients are Qi and Jing deficient.  It will be necessary to address these issues as well. The herbal formula such as Jin Gui  Shen Qi Wan is highly recommended. For many patients, emotional stress may have   been the cause of fibromyalgia. For such patients, Xiao Yao Wan and other Live Qi smoothing herbal formula are important.

5.5 Complications and related issues:               

Spine related low back pain

Our spine takes up the heavy load of the body. It works against gravitational pull. When the spinal bones are aligned properly, the body is most relaxed. When the bones are not aligned, it takes extra help from muscles to maintain up right posture.  Over time, the muscles become tired and the nerves of these muscles started to complain and life become unpleasant and pain ensures. What is next is that with pain, the muscle shortens. Shortened muscle would make the misaligned spine locked in position, unable to realign it self. 

The claim of fame for chiropractic is to realign the spine.  Many people get benefit from such “adjustment” for sure.  Acupuncture does not “manually” realign the spine. Instead, properly placed needle allowed the shortened muscle to relax because of Qi is unstuck. Once the shorten muscle relaxes. It no longer locks the bones in the strained position.

As a matter of fact, I always ask patients to move their spine with needles in place.  Since these needles are in their hands or feet, it poses no interference for movement. Such movement serves two important purposes, one is to realign the bones, the second, probably more important is re-educate the muscle. After the muscle becomes shortened for a while, the body (actually the brain) has become adapted to this posture in spite of the pain. After the re-alignment, the body would automatically drift to this misaligned position and become painful again. Re-education of muscles is important to achieve a permanent fix.

The above protocols for low back are very good for treating many spine related back pain.  The point SI 3 is particularly helpful, as it addresses the Du meridian which runs along the spinal column.  Alternatively, Hua Tao Jia Ji( along the spine.) can be very helpful too, especially for people with severe scoliosis.  I seldom use it because too many needles are needed.

A 30 plus women had back injury from horse riding. Her doctor placed an artificial disc on her back. She then developed excruciating back pain. I treated her following the above L-B protocol and N-S protocol, her pain disappeared. She resumed horse riding. The doctor decided that the artificial disc was a defected design and replaced with new improved version. The pain came back. The doctor had to removed the replacement the second time without putting any new one in. After some acupuncture, her back pain was totally disappeared. She was able to do horse riding with no problem.

People with severe scoliosis on the upper back can benefit from electro acupuncture on the spaces between the ribs together with heat therapy.

I treated a lady in her early 60’s with severe scoliosis this way. Her spine looked like a bow; a steel rod about  8  inches long was implanted to stabilize the bow. The left rib cage started to dig into her lung which severely reduced her lung capacity.  As she walked, she had to stop to catch her breath every few hundred steps.  After a series of treatments, the pain started to subside and the energy also improved dramatically.  She could walk around blocks  without getting tired.  Interestingly, there was no visible physical change after all those treatment on her scoliosis because the steel rod implant prevented it from changing. But her pain did not bother her any more.

Herniated disc syndromes, stenosis and other pinches nerves issues

Herniated disc problem is about the disc bulge and outward protrusion. Stenosis is about narrowing of the foramen (gapping hole) between the bone segments. Stenosis tends to result in nerve pinching. This is due to the fact that the gap is influenced by the tension of the muscles that are attached to different segment of spine. When muscles become too tense, gap narrows and pinching of nerve could happen. Alternatively, when the spine is not aligned properly, some gap will become bigger while other becomes smaller results in pinching of the nerve.  

Although, these are different disorders, the treatment are very similar in TCM. Just like the treatment of low back pain, the aim is to move the stagnated QI.  Follow the prescribed procedure for low back pain treatment, L-B protocol . Once the Qi is unstuck, the low back can move freely without pain. Then, strengthen the muscles that support the low back, paying attention to the posture. Make sure to keep good posture and keep the affected area properly warm.

Pinched nerve:

Frequently, the doctors will diagnose a painful problem as caused by the so-called "pinched nerve". The pain can happen in the back, with the sciatic nerve, at the knees, at the ankle, in the foot, in the neck, in the arms, hands. What happens is that nerves are been squeezed too tight due to narrowed nerve passage way . Most telling feature for pinched nerve is the numbing sensation in the extremities. If the numbness appears to follow the distribution of nerve, then the nerve root entrapment is likely the cause. The treatment will be to resolve the pinching following the protocols: N-S or L-B.

There are times when the numbness in the fingers or toes is not caused by the nerve root. In such situation, most likely it is caused by insufficient of blood flow. Usually, soaking in hot water a few times to increase the blood flow will resolve the problem. The exception is in the diabetes situation. The cause is still the reduced blood flow issue.

It is important to enhance the blood flow to the limbs to avoid the dire consequence of losing the limbs. Heat therapy, massage and movement are all helpful. Doing nothing is doomed to be disastrous.

Pain at the SI joint

Among the complaint about low back, one of the most frequent diagnoses is the pain at the SI joint. Si joint is one of the strongest joint in the body. It s involved in lots of body motion. It easily over used. In addition to the above mentioned treatment for back, it is often quite beneficial to use moxa. When using moxa, moxa on SI joint as well as painful spots on the hip such as GB 29, GB 30.

Sciatic pain, Calf pain and “Charley horse” 

Classical sciatic pain is caused by stressed pirifom muscle which crosses the passage of sciatic nerve. Therefore, an activity that increases stress of piriform muscle will aggravate the problem.  To move Qi, GB29, GB 30 (need deep insertion)or other points along the GB channel such as GB34, GB 41 are useful.  Often, the pain produces other stagnation of Qi and demands attention as well. These include spine, hip , thigh. Required. If all these problem do not get addressed. The result will be very short lived.

I often add electro acupuncture on GB30 and GB31, mixed mode for 20-30 minutes. It often get good result.

            Charley horse is the spasm of calf muscle. People run to get potassium supplement at the first sign of Charley Horse, often to no avail.  It does not work because even if a person ingested big quantity of potassium, it will not increase the blood potassium or tissue potassium significantly. Body will dispose it through urine immediately.

The problem in the majority of cases stems from shortened calf muscle either through overuse, like walking too much, running too much and the muscle did not have time to recover or due to poor circulation from exposure to coldness as swimming in cold ocean with improper protection for too long. Many people have it in the early morning when the room temperature is the lowest. So, it is related to blood circulation deficiency issue.  Many people have chronic tight calf muscle, without improving the tight calf muscle, it only takes a few things to trigger the problem.(Since  everybody is different. Some people do prefer to walk on cold slab to be cool. )

So the treatment priority is to improve the circulation to the calf muscle either through heating or through stretching-relaxing muscles. Relaxed muscle allows better circulation.  Needling or moxibustion on Lv 7, 8, UB 58, UB 59 will be able to fix such acute problem. The advice is to keep the legs and feet warm.

Tight calf muscle also causes numerous other problems. These include the ankle pain, plantar fasciitis and heel pain. Just like wrists, ankles are designed for flexibility, not strength. When calf muscles are shortened, the stress is transferred to the tendons surrounding the ankle. That would cause all kind of pain in the foot.

I once had a patient who had several surgeries done on the right knee but was O.K. with the knee in general. His left calf muscle was always tighter than left. He developed sudden pain on the foot one day.  The most painful area was between 2nd and third toe extended from web upward for about three inches long.  I found that there are couple ropy musculature near Lv7 below the knee and did moxa on them. In a few minutes, the pain on the foot disappeared.

Chap 6 Joint  problem:

What causes joint pain? What is joint inflammation?

Movable joints are designed for motions which allow the body to move around.   Complex joints enable more complex modes of motion.  For example, cervical spine has seven bones and eight joints which allow the neck to turn many different ways. Hands and feet have so many joints that allow us to do an incredible array of maneuvering.

To accomplish such task, joints have complex and integrated structure; bones which are strong to take physical load, cartilages to cushion contact surfaces between bones, synovial fluid to lubricate the joints, capsules to contain fluids, bursas to store the fluid. Furthermore, vascular systems around the joints supply nutrients and oxygen, neural networks to direct the motions and to provide feedback for status of joints. Don’t forget tendons and ligaments are what keep separate pieces of bones together. It sets the tension between two adjacent bones. They also are responsible for holding the bone pieces in the proper geometric arrangement necessary to accomplish the intended movements.

One important point to remember is that the spacing between the bone is avascular- no blood vessels, no nerves. It does not produce any pain. The joint gap can be totally destroyed and we would not know it. That is why artificial joints are possible. As we ages, the gaping between the joint such as in the knee become narrower and we have no inkling that is happening. Joint pain is not the pain inside the joint spacing. The purpose of joint spacing is that it provides a physical structure which allows the motion feasible and productive.

With arthritis, quite likely, there is inflammation at the surroundings of the joint by definition. The inflammation may or may be not the cause of pain.

The deep joint pain that often felt by some arthritic patients does not come from the space between the joint. It is produced by the nerve receptors which surround the joints. Injuries, strain, sprain of any kind around the joint, tendons, bursa, nerves, muscles all can irritate nerves. The swelling of any origin can cause irritation of nerves.  Muscles that are incapable of relaxing (either through overwork, neurological disorder or coldness)can cause irritation to nerves. All of these events produce the sensation that are not comfortable and contributed to various sensation, soreness,  pain– It can be like knifing, dull, achy, throbbing, distention, cutting, electrical shock, pulsating.

The 1^st responder for our body to the pain is the reflex protective shortening of muscles which reduce free motion at the joint. Inflammation process would likely also initiated which dilates blood vessels, allowing more blood, oxygen and body defender-immune apparatus to move in. Unfortunately, too much of these stuff all at one time and the flow becomes congested like traffic in an auto accident scene. The congestion results in swelling. Our nerves then sound alarm with pain and discomfort sensation. This explains why common anti-inflammatory medications which reduce inflammation process relieve joint pain to a certain degree. The “muscle relaxants” also brought certain pain relieve sometimes because it inhibits the contraction of muscles.

However, the most important question left unanswered is why inflammation occurs in the first place for people who never do anything to injure their joints but develop arthritis anyway. Most times, it is explained as “wear and tear”. If it is so simple, people in bed should not have arthritis. On the contrary, they do. Worse off, they would soon have atrophic muscles and degenerated joints throughout the body. It is interesting to watch doctor regularly tell patients that arthritis is caused by “wear and tear” of joints due to use and then turned around and advice patient to do more exercise, more walking to prevent arthritis.

Inflammation has been getting a bad rap. Such reputation did not start today. It was called “Fire” in Traditional Chinese Medicine for thousands of years. So is ancient Greek and Indian. People had been trying to extinguish the bad “fire” in the body for many thousands of years.  It has made lots of money for drug makers these days. Just take a visit at drug stores and you would be surprised to discover how much of the remedies are anti-inflammatory of some sort.

Yet, inflammation is the tool body heals itself. Without it, healing will be very difficult. Anybody who chronically uses anti-inflammatory will notice that. All the side effects attributed to the anti-inflammatory are caused by this reduction of healing process. The most notorious is cortisone. I once had a patient who came with whole body pain, bad joints, moon face, and hump upper back, severe cataract on both eyes. She was on cortisone for half of her life and she was only 50. I was able to reduce her pain and reduce cortisone dependency though acupuncture.

Granted, when the inflammation is overwhelming, it can be debilitatingly painful. In such event, steps have to be taken to bring pain under control. No question about it. Otherwise, normal body function will be impossible. Anti-inflammatory remedies can be necessary under such condition. This applied to the inflammation situation caused by autoimmune disorders as well in some acute phase severe inflammatory incidents.

By the same reason, frequent icing on the body also discourages body healing and should be avoided, unless it is followed by heating afterwards.

How does acupuncture help arthritis?

A lady in her 60s came in for knee pain, hurting day and night. She was referred from regional Kaiser Permanente.  In the past two years, she has had four cortisone shots that have minimal effects, followed with elastic tissue infusion into the joint. I did acupuncture and moxibustion (Acumoxa) on her right knee. Her knee pain disappeared, no pain for four days. Gradually pain started to creep back. Obvious, she had a severe case of arthritis.  This is but one of arthritis cases successfully treated with Acumoxa. Why did acupuncture help her knee and why did the pain come back? Because her condition needs long term continued care.

6.1       Painful joints or arthritis- degeneration

 “Degeneration” does sounds alarming, especially for the patient. In truth, it is not so dreadful at all. It can be minimized with proper care.

What is the degenerate disease? First of all, degeneration is a nature process that can’t be reverted, not even stopped. It is just part of life process- everybody over the growth spurt starts to have degeneration. The only thing that can be done is to prevent the unnecessary degeneration.

So, what causes excessive degeneration? The causes are too many to count. We will revisit this latter. In the end, it is the lack of blood supply that is the culprit. No blood, no oxygen, no nutrients, cells starved and wielder. Tissues weaken and decay. This will raise alarm and induce inflammatory reaction for relatively healthy individuals. Inflammation has been portrayed as villain in causing all kind of mischief. Indeed, it causes capillaries to enlarge, tissues to swell, temperature to rise, color to turn red. For sure, blood flow is increased but unfortunately, it is likely to bring pain with it.

Pain is a double edged sword. It  triggers protection reflex from the muscle which on one hand reduces mobility of the area preventing undue movement of the area but also increase the muscle, tissue tension that has unintended consequence of restricting blood flow.

So, the body has created a dilemma for itself. The art of healing lies in resolving this dilemma. The easy way out is to reduce the inflammation somehow. Such approach makes pharmaceutical companies a lot of money. They have developed varieties of anti-inflammatory medication from aspirin to naproxen, cox-2 inhibitor, all the way to the all powerful cortisones. They work wonderfully in reducing the inflammation but leaving the body to heal the problem without the tool-inflammation.

A 45-year old male was diagnosed with a severely-degenerated cervical disc and was told that surgery is the only option. His neck and right upper arm are painful. The right arm is numb. Numbness extends all the way down to the fingers. He had difficulty falling asleep because of pain.  

Put acupuncture needles on the right hand and elbow, the result was immediate. According to the patient, not only did the pain at the neck shoulder begin to diminish, but also a sensation of warmth traveling down the arm and hands. After 5 treatments, the patient was able to manage with infrequent successive treatments.

Comment:

Degeneration is a dirty word that provides covers for the doctor’s frustration. In truth, our body is in a constant balance act between regeneration and degeneration. Before 16 year of age, more regeneration, after that, more degeneration. This fact can't be changed. Nobody can prevent degeneration. However, most people don't have pain most of the time. Degeneration does not equate pain.  Pain of any origin accelerates degeneration and needs be addressed as soon as possible.

6.2       Golf elbow, tennis elbow

Either one can be very painful. The cause is similar- overuse of certain muscles. The muscle than shorten to protect itself which results in the stress at the respective tendons and the attached bones. The joints become stressed and immobilized from pain. In addition, the antagonistic muscle becomes overly stretched. The tension is then transferred to the attachment of corresponding tendon to the elbow, either medial or lateral epicondyle of the humerus muscle. As the result, either biceps muscle or triceps spasmed and become painful in addition to the corresponding insertion location at the joint.

Palpate and find the tenderest spots and do indirect moxa until the pain subsides. Do exercise to strengthen the underused muscle group and the problem will disappear. Meridians involved typically are Large intestine, Lung, San Jiao or Small Intestine. Again, keep the joint as warm as comfortable, stretching frequently the whole arm, especially the underused muscles is the best way to prevent future problem.

6.3       Frozen shoulder        

A 48 year old female complained about shoulder pain which kept her awake at night. She was diagnosed as having frozen shoulder. The pain started after a surgery a few months ago to fix the broken clavicle in an accident. A steel pin was used to stabilize the clavicle.  She needed left hand assists to raise right arm above shoulder level.   She was told that the encapsulation of the joint had caused the frozen shoulder. She also had another operation which fused C6-C7. Otherwise, she appeared healthy, trim.  She confessed to have some bad mood frequently.

Her neck’s sideway range of motion was reduced more restricted turning toward right. Palpation indicated that her chest under the right clavicle was quite painful under pressure.

            Encapsulation might have been caused her inability to raise arm normally. It normally takes a while to develop such problem and would take a long while to recover. However, since the “frozen shoulder” happened after the surgery, encapsulation is not likely to be the original or important cause of her problem. Therefore, this type of frozen shoulder is much easier to resolve. In contrast, typical “frozen shoulder” is due to aging, which involves an element of weakened Q takes much longer to resolve. In TCM, this is a Qi stagnation problem-Qi is stuck, not weakened, which cause the arm to “freeze”. Her shoulder Qi got stuck most likely followed the surgery.

To move the Qi, usual points to move the neck /shoulder points were used (N-S protocol). In addition, St 38 on the right leg and SI 6 on the right arm were used. I also applied moxibustion over the upper the chest nearing the shoulder and posterior to the shoulder joint just below SI 9.

She was amazed at the result; she was able to raise the right arm over the head without the assistance of left hand.

She came in the next week saying that not only she was much happier, everybody in the family was also happier because she was not as cranky any more. She had no pain using right arm during the week after the treatment. She still had pain in the chest and left neck upon palpation. The upper chest pain was related to the surgery, needed time to heal. In TCM, This is a “blood stasis” issue. Heat pads or moxibustion are the best home remedy for such problem. Both should be applied for a certain length of time to assist body to heal.

Frozen shoulder is not difficult to treat. For acute cases, it is a Qi stagnation and “coldness accumulation” issue; “coldness” due to reduced blood flow and Qi stagnation due to pain. Inflammation which is generally blamed for is not the cause of problem but the consequence. When people sleep, shoulder joints are exposed to the cold. With time, typically after age 50, the problem hit. Leaving it unresolved, muscle weakens, become atrophy. Fibrosis sets in. The range of motion of the joint begins to decrease.

Use acupuncture with or without electrical stimulation to move the Qi. Apply moxibustion or other mode of heat therapy to increase the blood circulation.  Add some stretching exercise of the arm and shoulder. Such problem would be resolved. Obviously, this is a chronic situation, without paying close attention to the environment of the shoulder, the problem might come back. People who have higher blood pressure have better blood flow have less of such problem. People who have “perfect “blood pressure or below the “perfect” blood pressure get this problem frequently.

6.4       Swollen joints and limbs- sudden onset or due to traumatic incidents

When fluid starts to accumulate in the tissue, the skin starts to become tight like inflated balloon. Achyness sets in because of the increased pressure on the nerve. This happens in a traumatic injury situation. It can also happen with other condition that produces inflammation.

The first issue is why people use ICE protocol, icing, compression and elevation to deal with traumatic injury. Such combination reduces the accumulation of the extracellular fluid. It stops the swelling from getting worse. But it is not very productive in reducing the swelling once it forms.

Lymphatic duct is what drains away the extracellular fluids. For it to work, muscle contraction. It gets a boost from heat. Icing slows down the process. This is where icing actually produces counterproductive consequence. The longer the icing, the longer the swelling stays and eventually may become permanent. The longer the affected area been kept motionless, the longer the swelling will stay.

One type of the swelling very difficult to deal with medically is caused by incompetent lymphatic nodes; either through removal from cancer surgery or other disorder like parasitic invasion.

Lymph nodes are like check valves. Removing them is like removing the drainage valves. That makes it unable to drain the tissue fluid from the affected limbs. Manual drainage becomes necessary. Without it, the swelling continues, eventually the fluid settles and becomes stationary tissue, making physical activity difficult.  To slow down such process, one need to keep the affected limb warm, keep its muscles moving, do manual draining, keep limb elevated at rest or wear compressive stocking walking. To certain degree, electro acupuncture across the inguinal or the shoulder joint plus heat therapy will help but the process needs to continue permanently.

Once I had a 50’s female patient who had a left leg twice as big as right leg. Her foot was all swollen, disfigured but regular size. The leg was so heavy that she was unable to lift it. It reminded me of the people suffering from elephantiasis which are caused by parasites (Filarial). This lady lived all her life in Los Angeles, never travel outside of the country. She felt better after acupuncture treatment but never came back for follow up. According to her, it started 20 years earlier when she was remodeling a house and became totally exhausted. It then developed gradually.

6.5       Rheumatoid Arthritis

6.5.1    78 year old lady complained about arm pain that was caused by “rheumatoid   arthritis. “ Both upper arms were hurting, worst on the right, tender to the touch interiorly. She could not straighten this arm because of pain. Left wrist was significantly bulged, significantly reducing hand flexibility. Her left hand was visibly swollen. Other joints were also hurting but not as much like the arm pain that kept her awake at night. Her fingers exhibited medium degree of disfiguration, typical of people with severe  chronic rheumatoid arthritis. Joints were warm to the touch. So was the rest of her exposed skin. She took aspirin and Advil to reduce her pain. She was allergic to many kind of medications. As a matter of fact, her Rheumatoid Arthritis had been a remission for a good number of years until she took prescription drugs about two years ago. It never stopped since.

No complaint of thirsty. Her pulse was fast and thin.

Her history revealed several surgeries in the past: hysterectomy, for the jaw mastoidectomy twice, mandibular surgery once. Her necks range of motion was limited, painful beyond 30 degree of rotation.

Ordinary, Rheumatoid arthritis belongs to category Hot Bi disease in TCM. The goal of treatment is to cool down the body. There are herbs that would have such function. These include Xuan Shen, Sheng Di, Zhi MU, Huang Bai, which would be benefiting to her overall. This is according to the Yin Yang balance strategy. Her body is in Yang excess for the time being. Excessive Yang caused her excessive overgrowth of bone at the joints which caused pain and resulted in the distortion of finger joints. Pain resulted in QI stagnation at the neck, arms, wrist and fingers.

However, her immediate complaint was of a different issue. It was the Qi and Blood stagnation issue.  Moving the stagnated Qi would help her condition significantly. To have a long lasting “cure”, more steps wouldl be needed, like addressing the Yang issue, the disfiguration of joints issue.

So I applied  N-S protocol for her neck and shoulder first. She had increased her neck’s range of motion by 100% to up to 60 degree both directions.  Moxa on the points at the elbow was able to reduce her pain 50% and Moxa on the left wrist, thumbs plus some passive stretching of fingers reduced her pain on the left wrist, increased her flexibility. She felt much at ease writing the check compared to earlier writing patient info sheet before treatment. No more pain.

6.5.2  Another  lady of  48 years old had history of rheumatoid arthritis, she already had surgery on both thighs and knees. Not much help to the pain.  She was walking on cane. She was on Ativan, extra strength Tylenol, Ibuprofen to control pain. Not much help. Sulfa drug caused her hive and swollen tongue, Haldol caused her facial paralysis, Percocet made her mentally confused and Erythymycin made her sick to stomach.

Though she was supposedly having problem with rheumatoid arthritis, there is no sign of excess heat in the body. She actually preferred warmth.  Therefore, applying low back protocol with needles around the knee joints plus warming her knees were enough to improve her pain condition. She was treated twice a month for about one year with good result. No need for cane to walk. She was advised to keep joints warm to prevent them from acting up.

Treating rheumatoid arthritis is a little tricky because in general it is a deficient situation which requires heat therapy, warm environment, warm herbs for body tonification. While at times, the body become Yang excess and needs be tone down using cold herbs. It is important to make careful judgment and treat accordingly. However, from the acupuncture perspective, either way, there is Qi stagnation issue that has to be corrected. If the therapist is totally blind sided by the “rheumatoid “ diagnosis, then the treatment won’t be very successful.

6.6       Gout

Gout happens to people who has too much of uric acid in the blood. Some food produces more uric acid when digested which normally would be cleared through kidney into urine. For some genetic reason, certain population has more uric acid in their blood stream. The problem is that Uric acid is a weak acid, it cannot dissolve in blood in quantity because blood is very mild alkaline. When the concentration of Uric acid exceed its solubility, it will precipitate out as crystal. Since the solubility of uric acid decreases with temperature, it preferably precipitate at the joints and the extremities like feet and hands. These areas of our body are the coldest part of our body. Crystal is a solid substances and acts like sands imbedded in the tissues around the joints and causing pain and inflammation. It makes the patient miserable.

One day a big guy showed up in school’s clinic with painful big toe. He had history of gout that flared up from time to time. Now it was big, red and hot.  I Instructed the student clinician to apply indirect moxa on the big toe. After five minutes the temperature of the big toe started to decrease. At the end of the treatment the redness, swelling and hotness subsided. The pain was also diminished.

On the surface, it appears to be contradictory to use hot moxa stick trying to bring relieve to the hot, swollen gout-ted toe.  It is not. This is the nature way our body functions.  A logical outcome if we remember that the heat from the moxa increase the solubility of the uric acid crystal and dissolve it into the bodily fluid which is been carried away in circulation. Heat also speed up the circulation which quickens the removal of uric acid rich fluid. Furthermore, once the deposited crystal and accumulated fluid were removed, the inflammation that make the toe hot, red and painful disappear.

Therefore, for gout sufferers, it is vitally important to keep the parts of the body like joints warm all the time and have uric acid under control. One day, through gene therapy, the uric acid issue may be totally eliminated.

Chapter 7 Foot and Ankle issues

 7.1      Drop foot

“Foot drop is characterized by steppage  gait. When the person with foot drop walks, the foot slaps down onto the floor. To accommodate the toe drop, the patient may use a characteristic tiptoe walk on the opposite leg, raising the thigh excessively, as if walking upstairs, while letting the toe drop. This serves to raise the foot high enough to prevent the toe from dragging and prevents the slapping. Other gaits such as a wide outward leg swing (to avoid lifting the thigh excessively or to turn corners in the opposite direction of the affected limb) may also indicate foot drop.[1]”

Adapted from http://en.wikipedia.org/wiki/Foot_drop

case 1:

      A young, somewhat cheerful, vibrant lady had complaint of severe headache. It had been debilitating. Her employer drove her to see me.  Upon exam, her muscles were tight over the entire body.    

Analysis and treatment:

Her neck and shoulder was very tight for sure. The headache was the result of tight neck and shoulder (Please refer to neck and shoulder problem section) which is easy to treat. I had done that numerous times. However, in such case, the result did not last for more than a few minutes. Turned out that that she was incapable of relaxing. Her body automatically tensed up. She was aware of such tendency. Whenever she was aware of her tenseness, she would relax which helped her symptom a little. But then she would get distracted and forgot to relax. Her body musculature then tensed up immediately.

Her past history interview revealed that she had had a major trauma. She was shot in the back 12 year earlier. The bullet scar was visible, about ¾ inches to the L-1 lumbar spine.  That gunshot paralyzed her legs for a long time.  Through her own will power, she managed to gain back full function for the left leg with some diminished sensation. The right leg was not as fortunate. This leg appeared to be about one third smaller than the left leg with severe diminished sensation. Worst of all, she could not flex her right foot.  Actually she was having a “drop foot” condition on the right. She walked by dragging her right foot! She depended on left foot to walk.  She did hide her gait rather well. When I asked her to flex her right foot, she could hardly flex the right foot, less than quarter of an inch maxes, trying as hard as she could master.  I could see the problem-that she was using her quad muscle to raise the foot. Her quad and calf muscles soon became  exhausted.

I used needles following my protocols to release the back and neck tension. Which was effective but her body overall remains quite tense. She does not have much feeling when needles were inserted on the legs, just pressure sensation. I proceeded to use electro acupuncture, between St36 and Sp9, GB 34 and S t41. I  added  Lv 3 and St 36 .  The result is non existence even with very strong needling technique. Only, a slight motion of the foot was observed in sync the rhythm of electrical pulsing. She still had no ability to flex the foot.

Turning point

I decided to remove the needles and instead using indirect moxibustion with smokeless moxa stick, applying to St36 which is the most power acupoint of YangMin meridian of the right leg.  I then asked the patient to flex the foot.  Amazingly, her flexing was improving bit by bit. Within 10 minutes, her foot flex’s range of motion wasabout 70% of normal people. She just could not believe it. It was quite exciting.

She came in the following week for another treatment. Her right foot was still doing very well. She did not have headache either. For the first time in 12 years, she could walk like normal people.

Historical anecdote

This is so interesting because only one point St 36 was needed. Hers is a case of treating “Wei Syndrome” or foot atrophy syndrome in TCM. This is intriguing. About 2000 years ago, according to Yellow Emperor Cannon of Internal Medicine, Yellow Emperor asked his royal court minister, Mr. Qi Bo, who he consult for medical questions, why it was said  in the literature that “ With  Wei Syndrome, treat  only the Yang Min meridian”.  Qi Bo replied that although Yang Min is the main meridian of choice, more meridians are involved because any one of the five Yin organs can produce to Wei syndrome. This answer became the standard answer of treating “Wei Syndrome” since that time.

In truth, it was not the correct answer. What Mr. Qi Bo did was to change the definition of the “Wei Syndrome”. The prevailing definition of” Wei syndrome” at the time of Yellow Emperor’s question was “feet atrophied incapable to walk”. Mr. Qi Bo changed the definition entirely. He used the term to indicate the atrophic symptoms of the body. His defined Wei syndrome as various body atrophy conditions caused by prolonged inflammation which exhausted Visceral Yin.  With this definition, Yang Min meridian is not particularly useful. This incident caused problems for TCM doctors for years to come.

For thousands years on ward, every TCM doctors on record would quote Yellow Emperor’s question, treated it as a statement and then just like Qi Bo simply dodged the question and explained why the statement in Yellow Emperor’s inquiry is not quite correct.

7.2       Acute incident caused “wei’ syndrom

Coincidentally, a month later, an old patient of mine came. He was a young man in his early 30’s. He was working hard in his friend orchard with heavy lifting and accidently lost balance and slipped. Afterwards, he had certain sore muscle in the low back and hip. His right foot became “heavy” which refused to go away for more than a week.  He had difficult working because of heavy foot which was also weak. Flexing the foot took some effort.

I tried couple methods treating the leg and low back that was caused his fall. The improvement on the foot was minimal. Then, I repeat the moxibustion procedure exactly like the previous case. The patient could literally feel the “heaviness” diminished. With three more treatments, the foot problem was eliminated.

Comment: Therefore, ancient doctors before Nei Jing’s publication were right about “Wei syndrome”, that “only Yang Min meridian is needed for treatment of Wei Syndrome”. There is one nagging question remains; that in the young lady’s case, I did initially use Yang Min, St 36 with electro acupuncture without success. Only through moxibustion was I able to achieve the desired result. The plausible answer is that there is significant Qi deficiency in her case due to long term nonuse. Much more Qi and Yang raising was required to get it going than electro acupuncture can offer.

7.3      case 2

In year 2000, I treated another case of drop foot. The patient was a man in his early 40’s. He had an incident and had surgery on the right tibia muscle group. The doctor who did the operation was quite skillful, yet he lost control of his right foot. He had developed drop foot.  I used electro acupuncture on the Yang Min meridian. With ach pulse, I could see his right foot flexing in sync with electrical pulse. It took a couple months to finish the treatment on once a weekly basis. In a few months he was able to regain the ability to flex the foot. No moxibustion was used.

Reference literature:

It is interesting to see other researchers also have similar experience about “drop foot”. Although more than Yang Min meridian was utilized in this following study.

“TREATMENT OF PERONEAL NEUROPATHY BY ACUPUNCTURE

                                             : A CASE REPORT  by Puo-Hsien Le1, Ching-Hsien Chang ^1,2

¹School of Traditional Chinese Medicine of Chang Gung University, Tao-Yuan, Taiwan Department of TCM, 2.Chang Gung Memorial Hospital, Keelung Branch, Keelung, Taiwan

                           ( Received 29th December 2008, accepted 27th February 2009 )

     "Foot drop is a deficit in turning the ankle to dorsiflexion due to the weakness of anterior compartment muscle. The patient with drop foot may use a characteristic hip hiking, steppage gait, tip-toe walk and foot slapping down to accommodate the toe drop. To prevent tumble, the ankle-foot orthotic are commonly used for the patient of peroneal neuropathy of cause unknown in Western medicine. From Traditional Chinese medicine's point of view, drop foot belongs to "leg flaccidity".

In this article, a case of drop foot received acupuncture treatment. The acupuncture points used were ST36, GB34, Jian Xia, SP6, and LV3. Among these acupuncture points, ST36 and Jian Xia were strengthened with electro stimulation. For this case, acupuncture treatment was effective.

Key words: peroneal neuropathy, drop foot, leg flaccidity”

Adapted from  J Chin Med 20(1,2): 79-85, 2009

Ankle problems

Most of the ankle problems come from injury.  Small injury like sprained ankle happens very often. Missed a step or have a fall and ankle would be messed up , painful, swollen, unable to walk.

As long as the bones are not broken and tendons not torn, sprained ankle is very easy to treat.  So, make sure the bones are not broken. Then,

First, warmed up the ankle, then, needle these points: LI 4 and LI11.  While moving the needle to get Qi, have the patient stretch the affected ankle. The pain should start to dissipate. Especially when the patient came in with swollen ankle, make sure to use the heat lamp to heat up the area first. Many people came in with cold swollen ankle after the sprain because they had been using ice to treat the ankle after the incident.  As long as the ankle remained icy, the swelling will remain. Heat is the best way to reduce the swelling.

With minor sprained ankle, the problem should be resolved with such treatment. If the sprain is more severe or lasted longer before getting treatment, some additional manual manipulation will accelerate the healing. The best way will be to perform isometric muscle stretching at the ankle.  

One day, we were walking along the Miramar Lake, I heard a boy biker crying his heart out. He was about 7 years old. He had his right shoe entangled in the hind wheel.  So the foot was hurting bad with any movement. His parents came over and tried to assure him, encourage him to be tough to no avail. I went over and grabbed his forearm with thumb on LI 11 and asked him to move the ankle. His father asked him whether it is hurting. After initial hesitation, he moved his foot and said no. Everything appeared as normal as before. He stopped crying. I walked away. It took about 3 minutes in all.

In this days and age, you should not do that without first ask for permission. I did not ask because of laziness, I did not want to answer a lot of question. It would have taken much longer to answer question then actually treat this boy. It might not even happen if the parents objected.

The same treatment is equally applicable to all other ankle pain. But if the ankle structure is altered, then, no assurance can be made for permanent fix. Once I had a male patient who had fusion of bones at the right ankle because of an accident that shattered the ankle bones.  He would come in and had had acupuncture, got pain relieve as well as increased flexibility of the affected ankle.  The pain, however, never totally disappeared. 

There are many other ways to treat the sprained ankle with good results. My method is by no means the only one. One famous acupuncturist Dr. Wei-Chieh Young liked to use a point called Xiao Jie which is on the thena eminence(pad of the palm). He claimed that its effect on sprang ankle is immediate. I suppose it is true as the point elicit a strong Qi. It may not be comfortable for patient though, so I have not used it myself.

Foot  pain:  Plantar fasciitis, heel pain

The first time I treated heel pain was with an early 30 year old  lady who loved to play base ball. She injured her heel in a game and her right heel became painful with weight. I first use heat lamp to warm up her foot, applied Zheng Gu Sui( a liniment for bone setting, muscle injury) and then use electro acupuncture, using Kd 3 and Kd6 for about 30 minutes. After about 6 times, the pain totally disappeared and she resumed her sport. I still do this way from time to time. But my emphasis have shifted to the calf.  As the calf is the source of the problem.

I would pay attention to the Lv 7, L8 and the surrounding muscles of the soleus.  Spasmed muscles can be felt around Knee area. Then I would apply both acupuncture needle as well as moxibustion to reduce the spasm, to move the stagnated Qi. Sometimes UB 47, 48 may have to be needled as well. Sometimes Kd 3, K5, K6 are added to increase the effect. The results are quite satisfactory. I apply the same method to people with complaint of plantar fasciitis as well as people complained of arch pain. The results are also immediate and good. My good friend Devatara up  in the Marin county , http://marinorientalmedicine.com/home/devatara-holman/  claimed to use Kd3 and UB60 with strong stimulation to treat plantar fasciitis with great result. This just indicate that there are more than one way to skin a cat( just joking).  Moving the stagnated Qi and the problem is resolved.

Chapter 8 Emotional well being

 A case of severe coughing

We know how important the mind has to the well being of our body. The manifestation of disorders caused by the stress upon our mind is unpredictable. Here is an example case.

Severe Coughing,  sinus?

A 60 year old female had complaint of sinus problem. The issue had been bothering her for a long time. She suspected that it is related to allergy.  She went through lots of allergy tests with no clear diagnosis.

She frequently had  stuffed nose, was treated with acupuncture and had good result. Now her complaint was having too much sinus fluid. Several times a day, so much fluid was produced that caused her to choke, with severe coughing. Such problem varies the severity with no clear pattern.

She also had issues with skin,  especially in the front aspect of upper leg. There was burning sensation just under the skin. Numerous reddish capillaries were visible over this area and no significant abnormity in appearance.   The skin over these troubled spots were not particularly warm to the touch. Frequently, she had eczema eruption on the palm between thumb and index finger. She had prescription lotion (low potency hydrocortisone) for this problem. This cream turned her skin to scaly, itchy surface.

At work, she had a lot of responsibility.  Job was stressful but she was able to handle it well. The coughing though often interfered with her work. It got much more severe when the job got stressful.

Pulse: wirly, Tongue thin white coating, front light red.

Past History: One of her parent was an American Indian. She had issue of feeling security as a kid. She frequently reacted with excessive fluid secretion in the throat that caused her to choke. She also experienced sensation of gasping for air and coughing.

Treatment and result:

Allergic  sinusitis is relatively easy to treat (refer to other articles in this web site). Depending on the sign and symptom, traditional Chinese herbal formula such as Xiao Feng San ( translation, extinguishing wind powder, which treat certain skin allergy as well), Pe Ming Gan Wan (for allergic sinusitis) are quite effective. In certain constitutional weakness situations, Yu Ping Feng San (Jade Screen Powder) will be quite beneficial. This can be done in conjunction with acupuncture at points: St 2, LI 4, Lu 5, especially coupled with electrical acupuncture.

Her problem was actually more complex. IN TCM (traditional Chinese Medicine), there are five kinds of coughing, all of the five Yin organs can have disorder (namely- Heart, Lung, Liver, Spleen and Kidney) that causes coughing. In her case, in addition to “Lung cough” due to “allergic” sinus issue, she also had “Liver cough”, which was aggravated when she became stressed, which was too common in her job. It was interesting to note that her coughing problem started as a child which was not an easy life for her. In any case, she and all the health care doctors since all attributed her coughing to the sinus allergy, which of cause had not worked too well.  

To resolve the Liver Qi congestion issue, a formula called Xiao Yao Wan (also called relax Pill) or Jia Wei Xiao Yao Wan (Relax Pill with added ingredients) often does wonder. Such is the case for her. Together with electro acupuncture, her problems disappeared almost entirely in just a few months (once a week treatment). It did not return since then. In the mean time, she learned to be better at relaxing at work. Interestingly, the skin problem which bothered her for a long time also started to ease and became a non issue.

Note: Coughing can be very difficult to treat, both by Eastern and Western medicine. It is the irritation of nerve causing a paroxysmal spasmodic reflective response of muscular event. Most of the time, it is the result of inflammation and /or infection due to a cold or allergy. In such instances, either clear or green yellow sputum are produced through coughing. For such cases, the most important treatment goal is to remove the inflammation/infection process.  Failing this, the coughing will not stop. 

 Chapter  9     Bladder and Urinary track issues

9.1       Interstitial cystitis

9.1.1    A 43 year old female had complaint of having “interstitial Cystitis.” The pain was centered at the bladder. In the good days, the pain was at 2-3 level in the scale of 0-to 10.  In the bad days, it was 9-10. The pain felt like rubbing alcohol on a wound, it’s sharp and burning.  It started gradually about 5 years ago. The pain never went away. One doctor diagnosed her condition as Interstitial Cystitis due to Hunter’s Ulcer inside the bladder. She was prescribed drugs: Elmiron,  Mobic twice a day, Pyridium 1 three times a day and Atarax one a day for a while now. The medicine did not seem to have any effect and she decided to wean herself off recently by reducing the medicine intake, which did not seem to make any difference in pain. In those years since the pain started, when the pain became intolerable, she would visit her doctor and have a procedure done. That happened about twice a year. The doctor pumped air into her bladder to stretch the her bladder( refer to the following). Although it is painful, sometimes it gave her some relieve afterwards, other times, no effect what- so- ever. Then she had to have another procedure within a few months.

“Bladder Distention from http://kidney.niddk.nih.gov/kudiseases/pubs/interstitialcystitis/

Many people with IC/PBS have noted an improvement in symptoms after a bladder distention has been done to diagnose the condition. In many cases, the procedure is used as both a diagnostic test and initial therapy. Researchers are not sure why distention helps, but  some believe it may increase capacity and interfere with pain signals transmitted by nerves in the bladder. Symptoms may temporarily worsen 4 to 48 hours after distention, but should return to predistention levels or improve within 2 to 4 weeks.

She was advised to pay attention on food intake, avoiding things like tomatoes, citrus. Although she did not experience any problem with food, she did minimize its intake. She has no problem initiating urination. The pain came after urination, so she drank plenty of water, 24-36 ounces per day.

Other history includes a herniated disc at  L3-L5 six years ago.  For which, she had disc-ectomy on the left of her spine between L3-L5. The operation did not resolve the back pain completely. She thought there was a connection between her bladder problem and her back but the doctor dismissed the connection.

Other features include: cold hand and feet, standing in the cool place for a while and her feet would go cold and numb.  Her hands ran cold in the cold weather, in severe condition, they turned icy cold, white and painful. Her pulse was a little fast, 85-90. In TCM term, she was Yang deficiency.

She also experienced tightness in the neck, worse on the right. She had it adjusted by chiropractors when it became too tense and uncomfortable. The result never seemed to last for long. Occasionally, she would have episode of migraine headache. Her bladder problem did not seem to be related to her menses at all.

Diagnosis and Analysis:

This is an interesting case because it is an IC, interstitial cystitis–like problem, because IC is diagnosed based on elimination of other pathological causes for bladder problem. She does not have other problems around the low abdominal area.  What is unique about this case as compared to other IC cases is that the patient has no food allergy issue.  No standard bladder sensitivity to food items. She could practically eat anything and nothing seemed to bother her. In other word, her problem was not rests on interstitial tissues of the ladder as would be for classical IC. As for the Hunter’s ulcer, she probably has that since childhood without any pain. So how did it cause problem all of a sudden much later in life without provocation (except back surgery)? One other point, if it were caused by Ulceration, the last thing that one would do is to stretch the bladder through compressed air.

It is quite clear from TCM perspective that her problem came from low back. The Bladder meridian goes through the back along the spine, where she had disc herniation. That back pain caused Qi of the urinary bladder to become congested which frequently resulted in pain.  Unfortunately the operation of disc hernia was not very successful. Her back pain continued after surgery of the back. In addition, the new pain with “bladder problem " was actually the result of back surgery.

What is also interesting about her medical treatment is that her doctor decided to stretch the bladder to relieve her pain which sometimes did relieve pain but other times achieved nothing. Such treatment should have been contra indicated if indeed her IC were caused by ulceration, the last thing the doctor should do is to aggressively stretch the bladder, because it could aggravate “ulceration” and make her pain intensify.  Therefore, the result does cast a doubt about the ulcer as the pathological factor.

From TCM perspective, it does offer a clue about the true pathology: by stretching the bladder, the Qi stagnation that caused the bladder problem, if done properly, was being improved. However, because the procedure can be very uncomfortable, it causes pain and pain invariable causes Qi stagnation and render the procedure ineffective. This explains why the procedure only works sometimes.

Treatment:     The goal for treating her “IC” is to remove the stagnation of Qi at her bladder. This can be achieved by addressing her back pain by acupuncture (refer to acupuncture for L-B protocol) and the bladder itself.  Both are easily achieved. As the result, her pain was significantly reduced after 6 visits.

9.1.2  A lady in her late 50’s was diagnosed as having IC. She had two grown up children and couple grand kids. About 10 years ago she started to develop this painful bladder/ burning urethra problems. There was a constant pain and ach in her low abdominal-bladder/urethra area, in TCM the Lower Jiao.  Needless to say she had to run to the bathroom constantly. Some doctors suggested that she had interstitial cystitis, while some other doctors did not agree. One doctor operated on her for “endometriosis” seven thousand dollars later, pain as usual. It did not help a bit. Her body was on the thin side, had problem sleeping as the result of incessant pain. Her low back was always achy as well.  She had a good marriage but intercourse had been excruciating painful.

She reported to have severe food allergic issue-tomato was on the top of the no-no list. Being an Italian descendant, that had been a major sacrifice in life.  There were many other items forbidden as well- anything that was acidic seemed to bring up intense pain in the bladder. She came to believe that her body being too acidic was part of her suffering. (I don’t agree with such line of thought. Refer to articles in my blog.)

Treatment:

First, I used points which calm her mind and body. Relax her neck and shoulder using the N-S protocol stated above, which happens often to people with chronic pain. I also applied IR heat over her low abdomen. This was quite pleasant for her. I then applied acupuncture using empirical point group –one third down from the perineum on the mid-line along the inner thigh with electro-stimulation in a mix mode.

Such treatment reduced her pain significantly; she could have more rest at night. In the second treatment, I added the Ci Liao points over sacral area  - also with electro acupuncture, because she reported that back achiness did not improve from last treatment. It had been preventing her from sleeping on her back. To my surprise, this pair of needle totally suppressed her “spasm urethra” pain.

She was treated once a week. Initially, the effect of treatment would last for a few days.  After a month time, she pretty much had minimal achiness throughout the week. She was very happy. However, one day she came in and I knew her problem had came back just by looking at her gait. It turned out that she had intercourse over the previous weekend which set off all the previous pain. I told her not to worry because this was to be expected.

She continued to make progress. In three months, she actually could start to enjoy sex rather than just endure shear pain after the act. Discomfort after sex became minimal and brief in duration.

Analysis:

As with other patients who suffered from interstitial cystitis, her pain was very sensitive to food intake. Before her first visit, she discovered that if she ate potassium carbonate, which is an alkaline chemical as supplement, her pain would be reduced a little. This seemed to confirm her suspicion that her acidic body was part of the culprit of her problem. There was one glitch to this therapy. She soon experienced palpitation and tachycardia, which is not pleasant. So she replaced it with sodium carbonate. If her theory had been right, she should also have similar pain relieve.  To her surprise, it did nothing for reducing the pain.

What she did not realize is that the potassium did not work the way she thought. It is NOT that alkalinity helped her pain; otherwise, sodium from table salt would have worked. Potassium is a highly regulated substance in the blood stream. Elevated potassium level in blood excites the heat rate. As a matter of fact, in open heart surgery procedure, surgeons routinely inject potassium into the blood to cause heart organ to beat so fast that it spasms and eventually stops. In her case, potassium caused her heart rate to increase which improved her circulation. As is true for most cases involving pain issue, increased circulation reduced her pain. (Cold also reduces pain sensation but through a totally different mechanism. Have possible long term side effect, if used for a long time. More on this topic later.)

9.1.3    A 54 year old lady complaint of both hip pains, worst on the right. She also had constant pain, in her shoulder, neck and low back. Frequently, she felt knifing, burning sensation at her low back. Her low abdomen was always tender, worst on the right side. Urination was painful so was sexual encounter even though she had good marriage. Over the last five years, she had several surgeries–two bone spurs surgery, bone fusion L4-L5 and S1. Nothing worked.

She was always constipated since childhood and had been regularly taking Aloe Vera and acidophilus to help bowel movement. She could only eat small portion at one time otherwise she would have severe abdominal pain. She is 5’6 95 lbs, prefer warm food, and love ginger soup, having cold hands and feet. Have difficulty keep body warm in the winter in Southern California.

She was diagnosed as having “interstitial cystitis” recently and her doctor recommended putting cortisone suppository in the bladder. She did not agree to it. She was on many courses of antibiotics. HRT (prempro patch), ibuprofen. Cranactin, organic Cranberry juice. She also took antacids and sleeping pill frequently.

Analysis and treatment:

Her condition is complex. At the bottom of the problem is this condition that in TCM called Yang deficient. Because of that, her body was incapable to repair itself resulting in all kind of problems. Aloe Vera which she used frequently for constipation also added her Yang deficient problem because it is a very “cold “ food in TCM. She easily qualifies as a patient of fibromyalgia.  The most important step to treat her is to tontify Yang. There are several TCM herbal formulas for this purpose. I put her on a formula made by Evergreen called Vitality for several months. It helped her to feel warmer especially during the cold of the winter(  in California, winter can be very cold.). Gradually her condition started to improve. She still had some painful issues because all the surgery done and yang deficiency issue but much easier to live with. She would come in for treatment from time to time.

9.2       Vaginal pain (vulvodynia)

Vagina is a complex organ, it contains several parts. It is often difficult to clearly pin point which part of the vagina is at fault. Most frequently, it is the inflammation of urinary track like bladder or urethra (UTI) that is the cause of pain. UTI causes severe pain both in urination and intercourse.  

One female patient in her mid 30’s with vaginal pain went to see four doctors and came up with four different diagnosis: hormonal deficiency, infection, dryness, inflammation.  Nothing worked.  I used electro acupuncture  at  points, one each leg, on the inner thigh, mid line, down about  three fingers width from Perineum. 30 minutes interval two times a week. This is an extra acupuncture point on the Liver channel which according to TCM encircles the vaginal area. The problem disappeared within a month. It was a case with minor inflammation of one spot of labiaminora that created a QI stagnation at the whole area. Soon she was pregnant which made her very happy.

This point that I used lies on the liver meridian. In TCM, Liver(Lv) meridian surround genitalia.  Other points on the liver meridian, Lv 3 in particular, is also good choice but not as effective in electro acupuncture because of the electro conduction issues. In electro acupuncture, the electrical current has to travel from one pole to the other. The longer the distance between the points used, the higher the voltage needed to get the same current flow.

9.3       Painful urination

This happens frequently with many women, very painful, hurting like being knifed. One potential problem is the infection in urinary tract which is called UTI in medical terms that involves overgrowth of pathogenic bacteria, mostly E. coli, in and around the urinary track.  In such situation, antibiotics work well.  Alternative, Chinese patent herbal formula can be used, frequently either Ba Zheng San or Long Dan Xie Gan wan are prescribed.

Frequently, bacterial is not the culprit. “Honeymoon” UTI frequently do not involve bacterial infection.  These problems could come from emotional triggered issues  as well as physiological. Because urinary track runs next to vagina, any gynecological issues would be affecting the urinary function as well.

In treating these problems, either moving Qi and Blood or smooth Qi will do. Acupuncture sometimes coupled with electric stimulation –electro acupuncture and or moxibustion offers good results.

53 year old female had a painful urination one day after visiting OB/GYN for a routine Pap smear. She went to Urgent care and was diagnosed as having UTI which she had once about 6 months ago.  The urine did not appear to be different from normal but the doctor maintained that it’s positive for white cells. The doctor prescribed her 10 days antibiotics, which gave her dry mouth. Next day, it did seemed to have helped somewhat. Although the urine appeared to be clear light yellow, she was told that it still has some blood and white cells.  Next day, she felt uncomfortable tension in the low abdomen.

The patient had been married for 10 years to the current husband. The husband has no interest in sex so she had not been  intimate  for many years. She appeared to be on the upper range of normal weight.

The patient had many grown up children. The last pregnancy was 15 years ago, delivered with c-section which led to a 6 inches horizontal scar, 3-4 inches below umbilicus. The scar is slightly tender to pressure at the left corner.

Her tongue looks normal light red with thin white coating and the pulse is slightly tight. The patient complained about being tired.

Diagnosis and treatment:

Most likely the patient had no UTI.  As with many patients who went through surgery, her surgical scar did not heal well that caused Qi and Blood stagnation according to TCM, Her low abdomen from time to time gave her trouble because of that. Her current pain was mostly triggered by Gynecological examine.

Treatment: The goal of treatment is to reduce the QI and Blood stagnation at the scar; this is achieved by using electro acupuncture coupled with moxibustion on and around the scars, particularly on the tender area. After the treatment, the pressure disappeared.

9.4       Frequent urination

These days, we are bombarded with commercial about “over active “ bladder. Medically, it is the symptom of frequent urination.  The bladder is not overly active, just a frequent urge to pee. People don’t have “overactive” nose when they are having running nose. It is a neurological event. Anything that irritates the bladder nerve and some surrounding nerves would cause such issues. These include excessive water intake, pregnancy. Infection or inflammation of bladder, vagina and urinary tracks as well as  prostate disorders all can irritate bladder. Look at such list, it is easy to understand why female are more prone to such problem.

Finding out the true cause will help selection of effective treatment. Infection can be handled mostly through antibiotics or through herbs useage. Usage of antibiotics often resulted in yeast infection, therefore, many people would take cranberry juice concurrently or instead of antibiotics.  In TCM, the commonly used herbal formula for such problem is called Long Dan Xie Gan Wan which clears heat toxin through urination or Ba Zheng San which reduces infection in the UTI.

IF no infection is involved, acupuncture would be very effective in treating frequent urination issue because it can smooth the overactive nerve or excess Qi. Ren 2, Ren 3 are very popular choice. My favorite is St 28 with electro acupuncture. Better yet, St 28 and the empirical points on the inner thighs on the Liver meridian. The results are quite good. Most of such patients have lower Jiao Qi deficiency or blood stagnation. So, use warm therapy concurrently is highly desirable.

Many pregnant women have urinary issues such as urge to pee frequently or difficult to urinate. Using St 28 would be difficult, but along the Lv channel in the upper inner thigh can be used.

Prostate problem easily cause frequent urination. Prostate related frequent urination which is not caused by infection( relative rare event for men) is quite unique. It is due to restrict urine flow, which can be resulted from incomplete empty of bladder each peeing. So the urge to go becomes a constant occurrence. 

9.5       Prostate issues

9.5.1    Prostate enlargement-frequent urination and dysuria

The true issue about prostate enlargement is the difficulty in urination and the resulting urgency and frequency of urination. It bothers many elderly men.

It is kind of curious to think that as men ages, everything in the body shrinks, including the bones. One exception is that the many male’s prostate gland grow bigger. It appears even more strange to realize that the only function for prostate is to increase the liquid volume (not sperm) to assist ejaculation. What is the Mother Nature trying to tell us with “enlarged “prostate? Knowing that more and more percentage of sperm are not viable as men ages anyway. Bigger testicles may help. Bigger prostate would not make any difference. It does not make sense. Furthermore, when a man can’t pee, there is no desire nor ability for sex.

I believe the problem is not about the size of the prostate organ that is causing the problem.  Remember, the urethra runs through the center of the prostate gland. Enlargement of prostate has little effect on the urethra.  The true culprit is the stiffness of the musculature of the urethra and the gland.  As with any other muscles in the body, they become stiffer, less elastic with age. Therefore, it becomes more and more difficult to move urine through the duct. The discomfort that is associated with the pressure further stiffens the duct. Therefore, soften these tissues and the urination problem would go away. 

I have a 75 year old patient who has had frequent pain and discomfort at the low abdominal area,  with elevated PSA. His sleep was disturbed because of the need to visit bathroom.  Using the points prescription in above section for frequent urination plus heat lamp over low abdominal area weekly. Everything began to work fine. Slept through the night. Currently, if he skipped the treatment for more than two weeks, the problem would start to creep back.

Chap 10   Digestive issues

10.1     Nausea and vomiting

Nausea can be caused by eating unfit food, pigged out, drank too much. It is the signal of stomach crying for help. The other possibility is the reflective reaction with headache or dizziness. Some migraine sufferers reported that vomiting relieve the migraine and would try to produce vomiting to avoid the migraine.  Obviously, this will mess up with digestive system. The third possibility is the pregnancy. 

For migraine or dizziness induced nausea and vomiting treatment, just follow the previous treatment method for migraine.  For others, PC 6(Nei Guan) is very important, so is LI 4. In addition, look for other issues. In TCM, all six Fu organs except for Urinary bladder, namely, Stomach, Large and Small Intestine, Gall Bladder and San Jiao are all involved in digestive functions. The important feature for these organs is that their Qi have to descend down. When any of these organs decided to strike, stuff started to back up and nausea, vomiting would happen.

So, depends on which of these nice organs are at fault, select points on meridians which related to that organ. For instances, when gall bladder acts up, select GB 34 or the most tender point adjacent to this point for needling. The same point will also be used for gall bladder stone.  Because it is coupled to Liver organ, add Lv 3 or some other Liver point will be good too.

10.2     Abdominal bloating

Many people have this problem.  After big meal, the digestive apparatus gets overload and refuses to cooperate. Some people are sensitive to certain food and develops bloated abdomen after eating those foods.  Some women develop such issues during menses.

In TCM, these are the Qi stagnation issue in the low abdominal area, or so called Lower Jiao.  The origin of the stagnation is the weak Lower Jiao Qi or for menses women, pain and discomfort of the low abdominal area cause Qi stagnation.

For weak Spleen Qi as well as acute onset of bloating, moxa St 25( Da Heng).  The problem should disappear. Alternatively, a patent formula call Chai Hu Shu Gan San which moves the lower Jiao (I, e. low abdominal area) will do. With herbs, proper dosage is important to be effective.

Do moxa the points that move the associated Qi.  Acupuncture also works. Points used are, LI 4, St 25.  Additional points that can be helpful: Sp 6, Ren 6, Ren4.  The bloating literally disappears in front of your eyes.

One evening, two student clinicians each had patient complained about chronic problem of constipation and abdominal bloating. In addition to other individual complaints. I advised the students to moxa St 25. The bloating stopped immediately after moxa. After treatment, both patients had to run for bathroom because of urgent bowel movement.

10.3     Loose bowel or constipation

A young lady came in because she could not eat food for a few days.  A few days earlier, she broke off relationship with her boyfriend and was devastated. After moxa on St 25, she felt hungry and went to get a big meal.  This is a case of Stomach Qi stagnation caused by emotional issue. In TCM, it is the Liver Qi stagnation causing Qi stagnation in lower Jiao.

A retired young marine had loose bowel issues for many years. He was diagnosed as having IBS, irritable bowel syndrome a busted knee that was operation on. He was tall, well built, otherwise healthy. The cause for his bowel problem was the stress and bad eating habit. So, with moxa of St 25 and IR heat over low abdominal area, once weekly for two months, his problem is basicly resolved.  However, if he could not manage the stress, frequent acupuncture visits would be essential for his health.

One of the common digestive disorders is called Celiac disease. In Western medicine the etiology is an allergic reaction triggered by certain food items. The pathology is inflammation of the intestine.  In TCM, it is also a case of weak Spleen Qi. The treatment is moxa of St25.  Moxa on St 25 is so important for the health of the digestive issues that I have used a lot. Some other points are also helpful for such condition- St 36, St37, St 39.  In addition, using heat lamp over the abdominal area are very helpful as well.

The other type of loose bowel is the weak Sp Qi. Tonifying Spleen Qi is the proper direction to go. The choice formula in Shen Ling Bai Zhu San.

Single herb can also be used. I like the herb He Zi or the combination of He Zi and Ge Gen.  Ge Gen is very interesting herb. It is the root of Kudzu which is such a vibrant plant. Ge Gen somehow carries its energy to our body.  A student of mine gave it to one of her patient who was losing lots of weight because of chronic diarrhea. She prepared these two herbs and the diarrhea stopped shortly after starting the treatment.

These herbs belong to the category of astringent in TCM. In the extreme case, like uncontrolled diarrhea, Ying Su Ke which is the shell of opium may be needed. The ingredient of this stuff stops intestinal movement. This explains why people on narcotic analgesics have difficult of bowel. With Acumoxa, use St 25 plus some points like Sp 4, St 36. For patients with severe diarrhea, it is necessary to watch out for the electrolyte intake, otherwise, dehydration may happen.

It is very instructive to observe that I use St 25 for both diarrhea as well as constipation or bloating of abdomen. Unlike in Western medicine, two opposite category of drugs are used.

10.4     Flank pain

            Pain, discomfort or unusual sensations in the region between the lower back and  the upper abdomen on either side of torso,

First thing to check is the history of kidney stone. If there is no sign of such event then it could well be related to pulled muscle issues due to a fall. Pain can be so severe and difficult to diagnose by Western doctors. The pain can be so severe that deep breathing becomes difficult.

Meridians of focus: Lv, GB

Additional points: relieve low back pain as well as points to relieve neck pain

            Moxa : St 18, Sp 6 , Gb25,26, St 25

Electro stimulation: UB 19 and Ashi   on intercostals area on lateral side of back at T7-T10 level.

Many people have this problem and it could create extreme anxiety among the sufferers as no test can show anything wrong yet the pain can be so debilitating severe.

Just treat these points mentioned, apply electro acupuncture and use indirect moxa on all the tender spots. The pain should start to subside. Eventually it will disappear.

10.5     Abdominal issues related to surgery

A 35-year old lady complained of right abdominal pain. She was healthy, liked to go bowling, but could not continue the game ever since an appendix operation a half year ago.
 The scar from the operation was very visible, about 4-inches long, slightly horizontal and in the middle of right lower quadrant. The tissue felt hard upon palpation, with slight pain when pushed.
            The therapy consisted of 8 sessions with a combination of electro-acupuncture, moxibustion along the scar and infrared heat lamps. The patient was able to resume her favorite sports after the sixth visits.

A female in her late thirties had chronic low abdominal pain that went on for a few years. Her appetite, digestion and bowel movement were all regular. She did not have any difficulty with urination. Her medical history included two ectopic pregnancies after a normal birth to a boy more than 15 years ago. She was finally referred to urologist and was told she had "interstitial cystitis".

She did not want to have an injection of anesthesia and anti-inflammatory medication as suggested by the doctor. She was apparently stressed over the problem. She wass rather healthy otherwise. Upon examination, two surgical scars were visible where the surgical instrument was inserted into the abdominal cavity, apparently to terminate the ectopic pregnancy. Palpation at the low abdomen revealed pain around the right scar.

Electro-acupuncture was performed as well as moxibustion near the painful spots. Only three treatments were required to completely eliminate the pain.  

This was not a case of interstitial cystitis. It is a case of misidentify. It was another one of the consequence of having unresolved scar tissue.

11.       Scar tissues issues

post operative and other unexplained painful issues

The scar tissue and adhesion from the surgery can cause significant health problems down the line. Sometimes the issue may not be obvious but people might suspect the link. One frequent population is from women who have had caesarian. They started having low abdominal issues like chronic low grade pain, constipation or general malaise which wax and wane with time. When severe, it can cause cramping, vomiting. Which lead to doctors to suspect Gall bladder problem or appendix problem. The best way to resolve such problem is to use moxibustion over the scarred area, using infrared lamps over the low abdominal area consistently until the problem got resolved. Some people needs a few times of treatment. In extreme cases, it could take years.

11.1  

   I had a 43-year old female patient who has a 3 inch- long surgical scar on the lower back from a disc operation. She comes in for acupuncture when the low back pain become intolerable, which is about twice a month. Acupuncture gives her complete relief of pain for a few days to weeks each time. Her case is by no means an isolated situation.

11.2 

    Post -operative pain is common among patients shortly after surgery.  What is difficult is to do right diagnosis. Often easily neglected is the post-operative pain that appears much later after surgery. Such problems can be successfully treated with acupuncture. According to the American Society of Anesthetists (ASA) 2007 Annual Meeting in San Francisco, acupuncture and Chinese herbs are very effective in reducing the post-operative pain. http://www.newswise.com/articles/view/533691/

One very interesting observation is that, often times, the pain onset can be years away from the surgery. There can be difficult for doctors to accept its cause effect.

Same thing goes with the physical injury, especially the injury to the head. The effect from the injury can show up long after the injury by which time the injuries have apparently healed.

The treatment method for such types of pain will be discussed later.

11.3     Why is post-operative pain so difficult to diagnose?

Because Qi and blood stasis caused by operation can't be detected by x-ray or other imaging method. The blood test would be normal. Medical doctors are often at a loss as to what is causing the pain. Even though medical history would reveal the prior surgery around the affected area, it is generally assumed that after the wound has healed, it should not cause future pain.

Often, there are shown as spots of hardened tissue resulting from healing process that are tender to the pressure. In some cases, medical doctors define them as neuroma.

What causes pain?

The Answer: Most likely, Qi stagnation and Blood stasis according to a TCM diagnosis. In TCM, it is recognized that such stagnations would reduce circulation and result in pain. It goes like” No circulation, there will be pain.”

This is the most important concept in pain treatment. Without the clear understanding of this issue, treating pain will be very frustrating. In modern pathology, pain is all about the nerves and the brain function. Numbing or killing the nerves, there will be no more pain signal and no pain sensation. Sedate the brain and there will be no more feeling of pain. Simple, right?  But life is not easy under such situation.  

On the other hand, from the perspective of Qi and Blood concept, if we can somehow restore the proper Qi and Blood flow, there will be no reason for pain.

Qi sounds so mystique and hard to grasp. It is actually quite easy to understand. Say you went to a party and had a good time.  Unfortunately, you had too much to eat. Your stomach becomes unhappy and painful. What happen? It is your stomach on strike- Stomach Qi stagnates. What to do? Insert a needle or rubbing your He Gu (Large Intestine point 4, the center of the thick web between the thumb and index finger.) The stagnated Stomach Qi will be moved and you start to feel yourself again. 

The following paragraph  in Italic is from textbook from UT medical school

http://neuroscience.uth.tmc.edu/s2/chapter06.html

Notice that in this paragraph, the chronic pain is explained in terms of "sensitization" .  Such explaination is not satisfactory to me. For one thing, if an acute pain is not properly taking care, the whole body starts to undergo changes to accommodate the pain. Such accommodation would create structural deficit which will be discomfort for many people, more for older than younger because the body's ability to accommodate. Such accommodation is a source for chronic pain. So, the key is still to resolve the problem caused by the acute problem and at the same time attending to the prolonged consequence due to the acute pain.  

"7.4 Chronic Pain

Chronic pain is prolonged pain lasting for months or longer that arises from tissue injury, inflammation, nerve damage, tumor growth, lesion or occlusion of blood vessels. Chronic or inflammatory pain can sensitize (see "Sensitization" below) the nervous system, evoking chemical, functional, and even structural changes that serve to “prime the pain-processing pump”. Chronic pain, such as lower back pain, rheumatoid and osteoarthritis, and headache (see "Headaches" below) may result from constant inflammatory activity which activates G proteins. In some cases, the pain persists long after the injury heals, but there is no treatment that will eliminate the pain.

Sensitization

One possible explanation for chronic pain is a phenomenon called sensitization. Following continuation and prolong noxious stimulation, nearby silent nociceptive neurons that previously were unresponsive to stimulation, now become responsive. In addition, some of the chemicals produced and released at the injured site also alter the physiological properties of nociceptors. The nociceptors begin to initiate pain signals spontaneously, which cause chronic pain. In addition, weak stimuli, such as a light touch that previously had no effect on these nociceptors, will further activate the nociceptors which result in severe pain signals. This phenomenon is referred to as “peripheral sensitization.” The outcome of peripheral sensitization results in a greater and more persistent barrage of nerve impulses firing in the CNS. The persistent barrage of nerve impulses results in long-term changes in nerve cell activity at the level of the spinal cord and higher centers in the brain. This phenomena is referred to as “central sensitization”. It appears that peripheral and central sensitization persists after the injury apparently has healed. The sensitization of nociceptive neurons after injury results from the release of different chemicals from the damaged area. It is known that substance P and calcitonin gene-related peptides are released from peripheral nerve ending which stimulate most cells to release algesic substances which further potentiates the pain from the injury. In contrast, central sensitization resulting from severe and persistent injury which cause prolonged release of glutamate on nociceptive dorsal horn cells, this constant glutamate release via G protein dependant phosphorylation cascades results in opening of postsynaptic ion channels gated by the NMDA receptors. This phenomenon is also termed "wind up." This activation produces hyperexcitability of the dorsal horn cells and causes "central sensitization." Pain experts now agree that treating chronic pain early and aggressively yields the best results and prevents patients from developing physical and psychological conditions that could worsen the pain."

Comment: Why do the Qi and Blood become stagnated?

Causes are so numerous. Stress, physical as well as mental, is the number one culprit. In many mysterious pain situations, they are quite likely due to prior surgeries or physical accidents that caused body injuries. The problem was not resolved satisfactorily which " sensitize" body to future pain.

Chapter 12 Icing or no icing

Most people came to my office or our school clinic because they are suffering from pain. IN our society, pain killer and icing seem to dominate the choice of therapy. Icing seems to be the golden rule of thumb for pain management. I had to admit it, I did that too long time ago. When my son jammed his finger playing balls at the age of 6. I had him immerse his swollen thumb in the ice water cup even when he fell asleep with head resting on the dinner table. That was 25 years ago; I was a senior scientist developing medical devices. I knew of nothing about acupuncture. If it were today, just one needle and some moxa, he would be good as new in no time.

Icing has an important place in the pain management- right after trauma. It is beneficial, depending on the severity of the trauma, up to several hours... Beyond that the benefit of icing should be very carefully evaluated. In my experience, it does a lot of bad thing for the patient.

Case in point, a 15 years old son of a patient wanted to know whether I could treat her son’s swollen ankle which had been bothering him for two years. He got sprained ankle in the soccer. After the incident he was treated by a medical doctor and went through a course of physical therapy and discharged. Two years later, he still walked with slightly distorted foot apparently due to pain. His left ankle was swollen laterally over ankle bone.

The mother did not seem to believe me when I told her that with acupuncture; sprained ankle needed only one to two treatments to resolve 80-90 percent of problem. I used Infrared lamp on his problem ankle for 20 minute, followed by a few acupuncture needle insertion. The main acupuncture points were LI10, Lv7 and Lv 8 on the same side of his affected ankle. Frequently, I asked him to flex the ankle.

After the treatment was finished, the swelling was 50 % smaller, the pain was almost 90% reduced.  After a couple more times of treatments, he started dancing with no difficulty.

The key reason for his prolonged ankle pain was icing. His mom was very meticulous in following doctor’s order, religiously icing his ankle, like daily ritual after his physical therapy had ended. I told her not to do it any more at home, instead, to the extent possible, use heat pack on the ankle daily.

This is not an isolated case. On the contrary, the practice of icing is so universally accepted that it became the first thing I discuss with patients with pain issues. I emphasize this practice in the school clinic that my students would automatically educate the clinic patients not using ice- not on the ankle, not on the back, not on the neck, not on the heat. Not on any place on the body.

Why not icing, after-all, isn’t true that doctors routinely prescribe icing to their patient after surgery or after trauma-  the triad ICE ( ice, compress and elevation)  is well established as rule of thumb for tending traumatic injury.

It is absolutely true and necessary in such situations. The purpose is to reduce the blood flow to the affected area preventing it from swelling. Everybody knows that tourniquet has saved many of our soldier’s life by stopping the blood loss. But because the blood flow is stopped, they often lost their limbs by amputation.

Although, not as severe to the body’s health, icing does reduce the blood flow to the affected part of the body and likewise jeopardize body’s ability to heal itself. So, it is very important to stop icing as soon as possible such as a few hours. Beyond which, continuing icing is not helpful and actually hinder the resolution  of swelling. Heat therapy should be started.

One argument for icing is for pain control. Some people have severe pain and doctors can’t heal them. With icing, they feel less pain. This includes headache, back pain. This is understandable but not a good strategy. The best advice I will give is to seek effective doctors. Remember, ice never heals. Body does. Blood circulation does.

Chapter 13 swollen limbs

Swollen limbs including ankles come typically with injury like sprained ankle.  It is easy to treat as long as no bone fractures involvement.  First, warm up the affected ankle like using hot towel soaking or heat lamp. Then needle LI 4 and Lv 3 on the opposite side. Finally, insert LI 10 and ask the patient to stretch the affected ankle. Gentle tapping the needle as the patient moving the ankle to make certain Qi is flowing. About 80% of mobility can be regained with greatly reduced pain and swelling.  Add a little isometric stretching for the lateral movement of the foot. About 95% improvement can be achieved in one visit.

Once in a while, some people would have swollen knee that seemed out of nowhere. Nothing unusual seemed to trigger the event. With swelling, walking would become painful and difficult to bend the knee.

This is caused by simple fluid circulation problem. The major objective in this treatment is to reduce the swelling. Ice should never be used. Instead, heat lamp or hot compress should be applied for at least 20 minutes or longer. In addition, electro acupuncture should be applied across the knee. Typically, one pair across Lv8 and St 36, the other pair across St34 and Lv 7, 30 minutes moderate intensity with mixed mode pulse. This can be followed with passively bending the knee repetitively for 5 minutes. Majority of swollen would disappear. A few more treatments and the swollen would be resolved.

A little more complicated situation can happen to people who have insufficiency circulation. Medically, nothing would show abnormal in lab tests.

A 41 year old lady felt her legs are getting more swollen day. After two weeks, the achy pain started to bother her and she visited her doctor and had many tests done including uric acid, and blood clotting factors. Nothing appeared abnormal. Doctor suggested using diuretic medication to purge water from the body which she hesitated.

She could not relate to anything which could have triggered this event. The swelling was quite apparent around the knees and the ankles, especially the left ankle. The elastic bends of the short socks created deep sinking bands about quarter inch deep. She was trim and quite active physically before this happened. The outside temperature is 72F and her fingers were icy cold, so were her feet. Her pulse was a little bit slow and thin, weak.

This is a standard case of Kidney Yang deficiency. The best treatment is Zheng Wu tang (True Warrior decoction) for a few weeks.  Since I did not have the formula with me, I have to rely on moxibustion and acupuncture.  First I use heat lamp on her foot and ankles. I then use smokeless moxa at the Kd 3, Kd 7 to tonify kidney which is a water organ in TCM. Then I did moxa St 36  on both sides followed by moxa at Ren 6. These two are most important Yang and Qi tonic points.  Then I needles LI 10 and ask her to wriggle the ankles. In a few minutes the tenderness of legs and ankles were gone and flexibility restored.  I then bent her knees 10 times, massaged her calves a little to stretch her muscles to further increase the circulation of the legs. I kept the heat lamp on for another 20 minutes.

After this, all of the swelling had practically disappeared. I asked her to get the formula indicated above for two weeks as follow up. Yang deficiency problem can’t be resolved instantaneously. That is why the need of continuing with either formula or acupuncture treatment is necessary.  Several weeks later she called and referring me one of her friend with same problem as hers. ( Actually, not quite from TCM perspective.) She took the herb formula as instructed and the problem never return.

The obvious question is that why did she had this problem now for no apparent reason? Given that Yang deficiency is more of a chronic problem. The answer is that she had had such Yang deficiency issue for a while.  As evidenced by icy hands and feet. It was not resolved for a long time.  The body was getting more and more depleted. She also had three surgeries in the low abdominal area in the past that consumed her Yang. Naturally, sooner or later, problem will show up.

Chapter 14 sexual assault and other difficult issues

Sexual assault is such a horrible crime. It could and often cripple the victim for life. It is very hard for the victim to escape the horrible imprint on their mind and body throughout their whole life. Recently, it is wonderful to watch the event of Jaycee Dugard.  http://abcnews.go.com/US/jaycee_dugard/jaycee-dugard-interview-diane-sawyer-future-surviving-philip/story?id=14040269#.TvawemHbzGY

She did set a remarkable example.  She shows great hope for many victims.  She understands that there is nothing wrong with her. She just had an awful luck of encountering with evil criminals. She would not allow herself to be continually victimized by those events. She loves herself, her life and tried to make the best of her everyday life.

To make it even more cruel to the victim is the fact often the perpetrators were the family members of the victims. I have seen a few of such cases. To overcome such trauma is very difficult. Some, however, do successfully turn their life around. One such person is my patient Myra. When I first saw her, she had the episodes of personality shift, turning into an out of control, nasty, crazy monster when she encountered something very unpleasant.  She had no awareness of such transformation until her husband could not take it anymore.

Anyway, she made remarkable transformation and was able to emerge from the dark side. She also wrote her journey down which was therapeutic to her. She published it in the book; “Homeward bound” and gave me a copy. I think it could be of some help for other people. I am so proud of her and happy for her.

I am duplicating the cover page of the book so that people who are interested can get onto the website www.mayagreentower.com and check the book out.

 Chapter 15 Acupuncture technique

            Acupuncture is both a science and art. No two acupuncturist do exactly the same   treating the same condition. If both are good, they would both get great results.  The challenge is to be good.

            I have many people to thank for in the process of learning. I also have obligation to share my five cents to people if it would help.

In the future, I would like to present some of the things I found useful as time allowed.

Once I attended Mr. Steinke’s seminar and liked it. I like his acupuncture approach because it is very logical.  It can be very helpful for beginner.  I do incorporate some in my practice.

            So, here it is.

20 steps according to John Steinke who is a well known sports acupuncturist:

1. Use as fewer needle as possible

2. Do it sequentially

3. Methods: bleeding(Jing-well for stagnation), needling, moxa(great for tendonitis)

4. Diagnosis: tendon, ligment, muscle, bone, internal organ

5. Select points: Tendon ( GB 34, Lv3); Muscle( Sp6, St36),  Bone( GB39, UB11, KD3 or 7);  Phlegm or fluid (sp9,   sp6 and St 40).

6. For scattered Qi, Du 20

7. Determine channel, use distal point first.

8. Choose Shu-stream for pain

9. Select related channels(i.e. according to flow of Qi, yang-ming, Shao-ying, Tai-yang,  Jie-ying, Shao-yang, tai-ying)

10. For upper limbs, treat lower limbs.

11. Treat opposite side, esp. from elbow to hand, knee to feet

12. Move the affected part of the body after insertion of needles, twirl the needles simultaneously with two hands across the body while moving.

13. Evaluate after each insertion

14. Select analog  point e.g. treat corresponding position on the hands for foot       problems

15. Use exterior/interior relations.

16. Use microsystem( one part of body related to the whole body  eg. ear)

16. Treat constitutional, i.e. Kd, Sp for deficiency

17. Reinforce by adjacent point

18. Experiencial point, eg. St 38 for frozen shoulder, PC 6 for Knees.

19. Secret Points. Lu5 and LI 10 to finish the remaining 20% of pain.

Other notable suggestions:

5 tigers ( on the thumb, promoted by Master Tung and his students.)for any arthritis           pain,

Ear points: especially good for acute problems, problems related to exocrine                                        membranes, pain, inflammation.

            Use corresponding points as injury organs, especially                                               swelling situation, sympathetic ( for diarrhea and exocrine membrane), adrenal, heat and subcortex((pain))

Ankle pain peaks on the 3rd day of injury.

Exercises: Ankle injury: raise heel 10 times a day.

Use St 36 and GB 34 for Knee problems for several reasons: deficient, adjacent , tonify.

Postlog:

The information presented in this writing is in no way to show off my"magical" touch. The point is to share things I found very useful from my experience. And  to point out the need to be open minded about the possibility. Specificly, do not be blind-sided by the "diagnosis". Look beyond the ICD codes. Do know the power and the limitation of modern medicine.

As we often emphasized, beware of what constitute as root and what constitute as bracnches. The body and the mind is the "Root", our intervention is the "branch". Understand the true nature of "Root" before trying to undertake the remedy.