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Pain in TCM
 

Pain in TCM

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Pain in TCM Pain in TCM Presentation Transcript

  • An Asian American Perspective Pain In Traditional Chinese Medicine
  • Disclosure
    • Conflict of Interest and Financial Disclosure
    • Pain in Traditional Chinese Medicine
    • Cathryn Hu, Ph.D., O.M.D., L.Ac.
    • President of Advanced Acupuncture, Inc.
    • Professor of Advanced Acupuncture Institute
    • NONE
  • Objectives
    • To relate:
    • The history and philosophy of Traditional Chinese Medicine (TCM) as it relates to pain management and healing;
    • The interface between body-mind medicine, cultural and religious practices, and spirituality within Asian-American communities;
    • The role of Qi (vital energy) in managing pain; and
    • The contraindications and precautions associated with TCM.
  • History of TCM in US
    • 1972 - China fever
    • Dr. Li-Beijing treats American
    • New York news report
    • Legalized Acupuncture practice in U.S.
    • Population of Practitioner in Asian American community
    • Flavor of Asia
    • People
    • Culture
    • Religion
    • Medicine
      • Thousands Hands of Buddha
  • History of TCM
    • Traditional Chinese Medicine
      • Acupuncture
      • Moxibustion
      • Medicinal Herbs
      • Cupping
      • Gua Sha
  • TCM Methods
    • Traditional Chinese Medicine
      • Acupuncture
      • Moxibustion
      • Medicinal Herbs
      • Cupping
      • Gua Sha
  • Philosophies of TCM
    • Natural Law
    • Holistic Approach
    • External & Internal
    • Normal Qi vs. Evil Qi
    www.holistictouchreiki.co.uk/images/chakra-lo
  • Yin & Yang
    • Yin and Yang Theory :
      • The Opposition
      • The Interdependence
      • The inter-consuming supporting relationship
      • The inter-transforming relationship
      • The infinite divisibility
      • Cheng, 13-15
    www. feandft.com
  • Yin & Yang
    • Clinical Applications :
    • Organic structure
    • Physical function
    • Pathological changes
    • Clinical diagnosis
    • Assessment/treatment plan
    • Cheng, Xinnong. Chinese Acupuncture and Moxibustion . 5 th ed. P16-19, Beijing: Foreign Languages Press, 2004
    Altmed.latp.org.ua
  • Five Elements
    • Theory :
    • Wood, Fire, Earth, Metal and Water
    • Law of movement
    • Clinical applications
    • Pathological relationships between organs
    • Guide to clinical diagnosis and treatment
    • Cheng 20-26
    www. lisaliclinic.com
  • Zang Fu (Organs)
    • 5 Zang organs: Heart, Liver, Lung, Spleen, Kidney
    • 6 Fu organs : Gallbladder, Stomach, Small intestine, large intestine, urinary bladder and triple energizer
    • Extra Fu organs : Brian, Uterus
    • The relationship between Zang organs
    • The relationship between Fu organs;
  • Qi- Vital Energy
    • Classification of Qi:
    • Primary Qi
    • Pectoral Qi
    • Nutrient Qi
    • Defense Qi
    • Function of Qi:
    • Promoting Checking
    • Warming Activating
    • Defensive Nourishing
    • Cheng, Xinnong. Chinese Acupuncture and Moxibustion . 5 th ed. P50-54, Beijing: Foreign Languages Press, 2004
  • Meridians www.acupuncture-medicine.co.uk
    • The basic concept of meridians
    • The Twelve main meridians
    • The Eight Extra meridians
    • The Twelve divergent meridians
    • The Fifteen collaterals
    • Cheng 60-112
  • Acupuncture Points Classification Nomenclature Point location Properties of the points Cheng, Xinnong. Chinese Acupuncture and Moxibustion . 5 th ed. Beijing: Foreign Languages Press, 2004
  • Traditional Chinese Diagnostic Techniques
    • Inspection
    • Smelling/Listening
    • Questioning
    • Palpation
    • Weiner, Richard. Innovations in Pain Management. P31-32 to 31-34 Orlando: Paul M. Deutach Press, Inc. 1993
    www. dkimages.com
  • Tongue Diagnosis
    • Inspect tongue’s size, color, moisture and shape as objective findings
    www.sacredlotus.com
  • Pulse diagnosis Checking the radial artery pulse to feel the rate, strength and quality www. Compassontedragon.com Weiner, Richard. Innovations in Pain Management. P 31-35 Orlando: Paul M. Deutach Press, Inc. 1993 Pulse Cun Guan Chi Left Heart Liver Kidney Right Lung Spleen Kidney
  • Differential diagnosis
    • Eight Principles:
    • Qi and Blood:
    • Zang Fu organs:
    Yang Superficial Hot Excessive Yin Interior Cold Deficiency Qi Blood Deficiency Hypo-function Insufficiency Stagnation Obstruction (pain) Hematemesis, (pain) Zang Heart Liver Lung Spleen Kidney Fu S. Int. G.Blad L.Int. Stoma. U. Bla. Tri. Bu.
  • Pain in TCM www. tcmchinese.com Bi syndromes = muscular rheumatism or collagen disease Cheng, Xinnong. Chinese Acupuncture and Moxibustion . 5 th ed. P474-475, Beijing: Foreign Languages Press, 2004 Wind Cold Damp Heat Wandering Bi Painful Bi Fixed Bi Heat Bi
  • Pain Management by Acupuncture Clinical Aspect of TCM
  • Acupuncture Pain Management
    • Overview of scientific bases of acupuncture
    • Mechanisms of pain management
    • Current researches and clinical trials
    • Pain Scores and evaluation methods
  • Scientific Bases of Acupuncture
    • Neurohumoral
    • Morphogenetic
    • Nerve Reflex Theory
    • The gate control theory of pain
    • Endorphin theory
  • Neuro-humoral Approach
    • Peripheral nervous system to be crucial in mediating the acupuncture analgesia
    • Meridian-Cortex-Viscera correlation hypothesis
  • Neurohumoral Approach
    • Acupoint-brain-organ
    • Acupuncture stimulates to brain cortex and nerve system, then control the chemical or hormone release to the disordered organs.
  • Morphogenetic Theory
    • Acupuncture points are singular points in surface bioelectric field
    • The role of electric field in growth control and morphogenesis
    • Organizing centers have high electric conductance
    • Acupuncture points originate from organizing centers
    • Shang C. China, 1989
  • Nerve Reflex Theory
    • Autonomic nervous system extending thru the internal organs
    • Viscera-mutinous reflex
    • Cutanous –Viscera reflex
    • Acupuncture utilize these reflexes for restoring the homeostasis of the body and acceralate the healing process.
    • -Ishikawa and Fujita et al, Japan, 1950s
  • The Gate Control Theory
    • Model for acupuncture pain relief
    • Specific nerve fibers that transmit pain to the spinal cord (substantia gelatinous)
    • Balance between Stimulation & inhibitory fibers
    • Short term block pain by acupuncture (did not explain the prolong effect)
    • Drs Melzack and Wall, 1965
  • Endorphin Theory
    • Natural Morphine
    • Acupuncture trigger the release of endorphin into the central nervous system
    • Only deal with pain
    • Corticoids and Substance P also released along with endorphin
    • Dr. Pomeranz, Canada, 1996
    www.pyung-an.com
  • Therapeutic Mechanisms of Acupuncture
  • Acupuncture Mechanisms of Action
    • Conduction of electromagnetic signals
    • Activation of opioids systems
    • Changes in brain chemistry-release of neurotransmitters and neurohormones.
  • Meridian-Cortex-Viscera Correlation Hypothesis
    • 1. The meridian system is and connected the nervous system to the cerebral cortex.
    • 2. It acts through neurohumoral mechanisms
    • 3. Acu-point-Brain-organ model: stimulates the brain cortex/nervous system, then controlling the chemical or hormone release to the disordered organs for treatment.
  • Morphogenetic Singularity Theory
    • Acupuncture points are singular points in surface bioelectric field
    • Converging points of surface current for change in electric current flow.
    • Abrupt transition from one state to another.
    • Eg: BaiHui (Du 20)
  • Physical characteristics of the acupuncture points-WHO
    • Points are corresponds to the high electrical conductance points on the body surface
    • High density of gap junctions at the epithelia of the acupuncture points.
    • Gap junctions are hexagonal proteins that facilitate intercellular communication and increase electric conductivity.
  • Research on Auricular points
    • WHO found 43 points have proven therapeutic value
    • Therapeutic effect can be achieved by needling, temperature variation, laser, ultrasound, and pressure.
  • Effects of Acupuncture on the Brain
    • UCI-Use functional MRI to investigate the mechanisms of acupuncture analgesia
    • Stimulates Li 4 revealed activation of visual cortex.
    • Needling Tin Hui revealed auditory cortex activation
  • Effects of acupuncture on the Brain-auditory cortex
  • Why acupuncture has fewer side effects?
    • May indirect adjust the process and restore normal function by activating the network of organizing centers in the organism
    • The activation of the self-organizing activity is less likely to cause the side effects resulted from directly antagonizing a pathological process which often overlap with other normal and beneficial physiological processes.
  • The role of electric field in growth control and morphogenesis
    • Enhanced cell growth toward cathode and reduced cell growth toward anode in electric fields of physiological strength
    • Fast growing cells tend to have relative negativity polarity.
    • The polarity is due to the increased negative membrane potential generated by mitochondria at high rate of energy metabolism
  • Efficacy, effective, safety and costs of acupuncture for chronic pain
    • Evaluated 304,674 patients over 10,000 physicians and received 10+ acupuncture for pain
    • Results: acupuncture was an effective and safe treatment
    • The effects attributed to specific or nonspecific mechanisms and depend on the diagnosis-results a large research initiative.
  • Mechanisms of Acupuncture for Pain Relief
    • Polymodal receptors
    • (PMRs) in the acupuncture points are sensitized for the immediate action.
    • Action mediated by endogenous opioids
    • Potent stimulus for activating the analgesic systems
  • Therapeutic Mechanisms of Acupuncture
    • Inserting a needle provokes an acute defensive inflammatory response
    • Afferent nociceptive (pain) neurons distribute to the dorsal horn of the spinal cord
    • Trigger the gamma loop efferent in the ventral horn and activate neurons that cross over the spinal cord to the brain
    • Activate somatic motor nerves
    • To muscles, and autonomic motor nerves to peripheral blood vessels and to the internal organs
    • Dr.D. Kendall, 1980
  • Acupuncture Pain Management
    • Part II: Clinical applications
    • Differential diagnosis and treatment for
    • Headache & migraines, Trigeminal neuralgia,
    • Carpal Tunnel Syndromes, Arthritis, Neck
    • pain, Fibromyalgia, lumbago and sciatic
    • neuralgia.
  • Etiology of Headache
    • Blood Vessels that become dilated enlarged or constricted
    • Muscles in the neck and head become tight or tense
    • Muscles around the eyes the become strained due to overwork
    • Sinuses became swollen due to allergies or infections
    • Nerves that transmit abnormal pain signals
    • Joints in the jaw and neck are overused or damaged.
  • Types of Headache - Western Medicine
    • Vascular headache (Migraines)
    • Muscle contraction headache
    • Combined vascular & muscle contraction headache
    • Headache of nasal vasomotor reactions
    • Headache of delusional conversion or hypochondriacal states
  • Migraine Headache
    • Classic Migraine
    • Common migraine
    • Cluster headache
    • Hemiplegic and ophthalmoplegic migraine
    • Lower half headache
  • Headache Principle acupuncture points
    • G 20
    • Taiyang
    • Li 4
    • GV 20
    • Liv 3
    • G 8
    • T 3
  • TCM Classification of headache
    • Headache due to invasion of pathogenic wind into the channels and collateral:
    • Headache occurs often, especially on exposure to wind.
    • The pain may extend to the nape of the neck and back region.
    • Tongue white coating, pulse floating
  • TCM Classification of headache
    • 2. Headache due to upsurge of liver-yang:
    • Headache distension of the head, irritability, hot temper, dizziness, blurred vision,
    • Tongue red with thin and yellow coating
    • Pulse thin wiry and rapid.
  • TCM Classification of headache
    • 3. Headache due to deficiency of qi and blood:
    • Lingering headache, dizziness, blurred vision, lassitude, pale complexion
    • Tongue pale with thin white coating’
    • Pulse thin and thread
  • Trigeminal Neuralgia (TN)
    • Causation:-blood vessels compressing the Trigeminal nerve root as it enters the brain stem
    • Peripheral pathology-neurovas compression
    • Central pathology- hyperactivity of the trigeminal nerve nucleus
  • Classifications of TN
    • Western Medicine:
    • Typical
    • Atypical
    • Pre-TN
    • MS-related TN
    • Secondary or tumor related
    • TN neuropathy
    • Post traumatic TN
    • Eastern Medicine
    • Pathogenic wind and cold
    • Ascending of Liver and stomach fire
    • Deficiency heat due to liver yin deplete
    • Damp/heat or damp cold accumulation
  • TN-Pathogenic Wind & Cold
    • Clinical manifestation:
    • Acute onset
    • Usually affects V1 sensory
    • Aversion of wind & cold or aggravated by
    • Pain like cutting, boring and electric shock but transient ( few minutes)s
    • Wind cold or wind heat symptoms
  • Tx-TN Pathogenic wind & cold
    • Acupuncture:
    • Yang bai, (GB14)
    • Taiyang, (extra)
    • Zan Zhu (Bl 2)
    • Wai guan (SJ5)
    • He Gu (Li 4)
    • Herbal formula:
    • Jin Fang Bai du San plus Ginger
  • TMJ-Tempro mandibular joint Dysfunction syndrome
    • Symptoms:
    • Grinding teeth,
    • Joint pain,
    • Headache
    • Ringing in the ears
    • Unable to open his or her month wide or hear a “pop” upon opening
  • TN-acupuncture treatment
    • Li 3 or Li 4 plus
    • Temporal branch:
    • Taiyang, G 3 & G 14
    • Maxillary branch:
    • G1, St2, SI18, and ST3
    • Mandibular branch:
    • St6, St 5, and G2
  • TMJ (TMD)
  • TMJ-Etiology
    • 1. Muscle spasm- pain
    • Masseter & temporalis
    • 2. Meniscus-cartilage, buffer between the jaw and skull. Caused “pop”
  • TMJ-Acupuncture points
    • ST 7
    • SI 19
    • T 17
    • Li 4
  • Osteoarthritis
    • Arthritis due to destruction of the cartilage, bone and ligaments
    • Causing deformity of the joints
    • Damage to the joints can occur early in the disease and be progressive
  • Rheumatoid Arthritis
    • Auto-immune disease
    • Chronic inflammation of the tissue around joints , organ and body
    • Body tissues attacked by own antibodies in the blood level which causes inflammation.
    • Women to men: 3:1
  • Osteoarthritis
    • 90% of arthritis
    • Destruction of the cartilage, bone and ligaments causing deformity of the joints
    • Damage to the joints can be progressive
  • Differential Dx of RA/OA
  • Principle Acupuncture Points for Arthritis Temporo-mandibular ST7, SI 19, T 17, Li 4 Shoulder joints: LI 15, T14, SI 11, T3,G 34 Elbow joints: Li 11, T10, Li 4 Wrist & joints: T5, Li 10., LI. 4 Lumbar spinal joints: Huatuoparaspinal acupoints, UB37 and UB 40 Lumbosacra Joints: GV3, B30, B 25, B40 B 60 Sacroiliac Joints: B 27, B28 Hip joints: G 30, G 29, G34, G39 Hip joints: G30, G 29, G34, G39 Knee joints: St 34,St 36, Sp 9, G 34 Ankle joints: ST 41, T 40, K3, B50, G 35 K8 Metatarsophala-ngeal joints : Sp 4, B 65, G 38, Sp 5
  •  
  • Causation of Carpal Tunnel Syndrome
    • Painful neuropathies of the hand and wrist are from nerve compression, most often compression of the median nerve in the carpal tunnel.
  • Anatomy of CTS
  •  
  • Diagnosis of CTS
    • Numbing pain in the distribution of the median nerve but not limited to it.
    • Phalen’s sign positive
    • Tinel’s sign positive
    • Light touch/vibratory touch positive
    • Muscle weakness and atrophy
    • EMG: slowed conduction velocity across the CT.
  • Etiology of CTS
    • Median nerve compression by tendonitis
    • Usually due to repetitive motion of the wrist and hands.
  • Carpal Tunnel Release
    • Surgery:
  • Carpal Tunnel Syndrome Principle acupuncture points
    • P 6
    • P 5
    • T 4
    • T 5
  • Cervical Spondylosis Principle acupuncture points
    • SI 3
    • G 39
    • B 64
    • B 11
    • G 21
    • GV 16
    • T 10
    • B 10
  • Rotator Cuff Syndrome Principle acupuncture points
    • Li15
    • Si 11
    • T14
    • Li 16
    • Li12
    • Li4
    • L 7
    • L 9
    • T 9
    • T 4
  • DX of Lateral Epicondylitis (Tennis elbow)
    • History of tennis elbow use
    • Pain just distal to the prominence of the lateral epicondyle
    • Radiological study negative
  • Knee Tendonitis
    • Patellar Tendonitis
  • Achilles Tendonitis
    • Runner’s injury
  • Lower back pain-Etiology
    • Herniated Disk (bulging)
    • Facet joint syndrome
    • Sacroilliac joint syndrome
    • Myofascial syndrome
  • Low Back Pain-diagnosis
    • Clinical history
    • Physical examination
    • Pain sensitive structures
    • Pain generators
    • Radiological studies
  • Low Back Pain-X-ray
  • Low Back Pain-MRI
    • Imaging study to evaluate the entire lumbar bones, discs, soft tissues and nerves.
    • CT, myelography, and discography use to complement MRI
  • Referred and Interactive Low Back Pain
  • Referred and Interactive Low Back Pain
    • The frequent referral of “ somatic pain into the limbs
    • Cause of the cause: Identify the source of symptoms.
    • Make realistic prognosis based on the stage, severity, stability and irritability of the dysfunction
  • Referred and interactive- Low Back Pain
  • Low back pain Principle acupuncture points
    • B 40 & K2 (basic)
    • L5, B 40, G34, B 65, B 60, B 34, K7, L 5, Li 11, Li 4, Sp6, Liv. 2, Li 10.
  • Sciatic Neuralgia Principle acupuncture points
    • B 23
    • B 30
    • G 30
    • B 36
    • B 37
    • B 40
    • G 34
  • Traumatic Injury-Brain-TBI
    • Clinical manifestations:
    • Altered mental status
    • Communication disorders
    • Emotional and psychitric disorders
    • Related paralysis or paresthesia
    • Dx: Refer to physician for further investigation.
  • Cause of Neck Pain
  • Radiological Findings of Neck Pain
  •  
  • Diagnosis of Fibromyalgia
    • Widespread aching > 3 months
    • Skin roll tenderness & hyperemia
    • Disturbed sleep with morning fatigue and stiffness
    • Absence of lab. Evidence of inflammation or muscle damage
    • Bilateral tender points in at least 6 areas.
  • Contraindications & Precautions
    • Contraindications:
      • Pregnancy- limited points (Lee & Liao, 1990)
      • Cardiac pacemaker (Lee & Liao 1990)
    • Precautions:
      • Epilepsy- cautiously managed (Weiner, 1993)
      • Drunk, exhausted, weak, or fasting (Weiner, 1993)
  • Risk and complications
    • Non sterile needle
    • Improper techniques
    • Vasovagal reaction
    • Misdiagnosis
  • Resources
    • Cheng, Xinnong. Chinese Acupuncture and Moxibustion . 5 th ed. Beijing: Foreign Languages Press, 2004
    • Hu, Cathryn. Developing a California Acupuncture Residency Program .
    • Riverside : La Sierra University. 2002
    • Weiner, Richard. Innovations in Pain Management. Orlando: Paul M. Deutach Press, Inc. 1993
    • Wiseman, Nigel and Feng Ye. A Practical Dictionary of Chinese Medicine . 2 nd ed. Brokline : Paradigm publications, 1998
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