Chapter 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.     

Chapter 2: Wang’s neck and shoulder protocol (part 1)

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 especially with lots of elderly. Some of them may have a significant reduction of range of neck but may not be aware that they have the problem. It kind of creeping up gradually on them, little by little until most range of movement is lost eventually. After treatment, they would notice that they do not need to turn the shoulder to look for the incoming car while driving anymore. They just turn their neck, naturally!! 

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.

  Graph from :  http://nursing411.org/Courses/MD0556_Basic_Patient_Care_Procedures/2-06_Basic_Pat_Care_Proc.html

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

         Basic:  (done bilateraly)

                    Luo Zhen 

                   SJ 10   

 Exam: Ask the patient to do neck rotation. 90 degree without tension is healthy. Otherwise, there is some issue with the neck and shoulder. Treat with N-S protocol

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.

Chapter 1: Calm the mind and settle the 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 lost in desert or ocean, as the physical bodies were stressed  to extreme, they start to see things that are not real. One such example is shown in a NPR documentary on body and mind. It is quite fascinating. Fighter jets pilots under high G force saw themselves flying the jet plan along with them. ( For this topic, do refer to Professor Ramachandran’s work  or  http://psychology.ucsd.edu/people/profiles/vramachandran.html).

To the extent possible, mental issues must be addressed at the very beginning of any therapy visit. It is vital to the healing process.  In addition to address the emotional stress with concilling, there are several acupuncture points that are very helpful for the stress of mind and body. Among the most common points are He Gu, LI 4, one on each hand and Tai Chung, Lv 3, one on each foot.  

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 bone” 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. were 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 . It will boost 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 gets resolved. In early pregnancy, presumably the body still regard the fetus as some foreign invader and will facilitate it departing.

One pregnant woman was overdue for two weeks became concerned because no sign 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. Such practice were recorded over thousands of years ago.

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 using Nei Guan for vomiting is widely known, including numerous gynecologists. Together with ginger soup, stimulating plus fresh ginger roots are becoming standard choice for nausea and vomiting problem during early pregnancy . Important to note that the He Gu, good as it is for stomach upset, should never be used at this stage of pregnancy. If this point is to be used, I recommend it be done with moxibustion not needling.

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 utilizes a set of five acupoints on the ear lobes. Such 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

He Gu, LI 4

Yao Tong Xue( extra point) consists two points. I use just one

Lv 3,  Tai Chung, a powerful Qi regulating point

Nei Guan, PC 6

 Note: Nei Guan is located at the forearm under the thumb in the above figure. Figure comes from Source:      http://www.pyroenergen.com/articles07/motion-sickness.htm