So, a few times this year, I've been presented with cases of simple toothache. Normally, my response has been, "Have you seen your dentist?" Of course, with this economy, dental plans are even scarcer than regular health coverage. For emergencies, however, people still go to the dentist but are often in pain before they get the problem resolved.
Friends who know me know that I love to use luo-points whenever possible, because they do a lot, but the Large Intestine luo, Pianli, has proven itself a marvel in controlling the pain from tooth decay. Naturally, it can't stop the decay, but it can ease the suffering. One person I used it on asked me, "Is it supposed to work that instantaneously?"
This supports the chapter from the nei jing about luo pathologies, wherein it states that the luo-channel excess indication for Pianli L.I. 6 is tooth decay and deafness, while luo-channel deficiency signs are cold teeth and obstruction of the diaphragm.
I should add that whether deficiency or excess, one should probably refrain from activities that strip away the enamel from the teeth. Flossing and brushing are good, sensible actions, but over-brushing with harsh toothpastes can damage the dentin. Similarly, an excess of coffee can undermine the teeth by leeching away minerals from the system. In TCM terms, coffee's hot, descending and yin stealing nature harm the Kidneys, of which the teeth are the odds and ends. Too bad I love the stuff.
Sunday, November 15, 2009
Friday, October 16, 2009
Ginseng Update
Just a quick note: my patient who's built like the Hulk and who has raging heat going on inside came in today, and hasn't had a dram of ren shen (Radix ginseng) for the last two days. Already, he says that he's sweating less, and his tongue definitely looks less angry. Hooray! A patient that actually listens!
Herb Soapbox
Well, I just finished watching Current T.V.'s excellent Vanguard. The episode was entitled, "The Oxycontin Express." Watching it, you realize two things: 1) Nothing good ever came out of any Bush administration anywhere, and 2) that with the damage being done by legal drugs, specifically painkillers, the FDAs reasoning for barring herbs to practitioners makes even less sense than ever.
Horrifyingly, eleven people per day in the state of Florida drop dead from overdose on painkillers, mostly oxycodone, an artificial form of heroin. Yet, oxycodone is not banned; not only is it not banned, but it's actively pushed in literally hundreds of "pain management" mills in Florida, most of them in Broward County. Yet, with only a handful of deaths attributed to it, ma huang (Herba Ephedra) is banned for use.
I should point out that I do support the banning of ephedra from supplements and other forms of snake oil. Manufacturers of these supplements are abusing a substance in a way never intended. Contraindications for ma huang in the Chinese medical literature clearly state that dose and duration of it should be limited, as it has a tendency to plunder yin if taken too long. However, as was observed a long time ago, Americans have a tendency to take any kind of hokum-in-a-bottle and ingest it, if it promises happiness, a slender figure, and health. Knowing this, supplement makers will go ahead and abuse medicinals like ma huang, and chen pi (Pericarpium citri reticulatae), if they can make a buck on it. The net result is to make life hard for those of us who have studied these herbs and use them in the way that they're supposed to be used. As a weight loss supplement, ma huang is a terrible idea. As a medicinal, in the right situations, it works almost miraculously. The fact that supplement makers are systematically putting more and more of the Chinese pharmaecopia out of reach is outrageous.
More outrageous is the fact that pain management mills in Florida, the Pusher State, can dispense tons of painkillers, hooking thousands of their fellow countrymen, destroying lives, and that they can do so legally. The problem goes beyond Florida, as well. As was pointed out on Vanguard, the impact is felt as far away as Ohio, as more and more citizens make the pilgrimage to Florida to get their OxyContin fix. In Greenup County, Kentucky, 90 percent, that's 90 percent, of people in jail now are in due to oxycodone related crime; either trafficking in it, stealing to pay for it, or theft of it. There isn't a family in the county (and, I'm betting, the state) that hasn't been negatively affected by oxycodone and its use and abuse. Yet, the FDA has chosen to ban ephedra (and will probably ban other herbs as they become the next season's brand of supplement snake oil) rather than oxycodone and other painkillers.
I should also take this opportunity to point out to all medical doctors who say that we in acupuncture are quacks to take a good look at your colleagues down in God's Waiting Room, and at the damage they're doing. If it waddles like a duck, and makes a distinct sound like a duck...
As an acupuncturist that works in a harm reduction clinic, I should also point out that I have a lot of patients coming to me for pain. Most of them are addicts trying to get their lives together. Usually, they come to me for help with pain because they themselves are afraid of oxycodone, and have explicitly told me so. If former heroin users are afraid to go near it, then everyone else should be terrified of the stuff.
Horrifyingly, eleven people per day in the state of Florida drop dead from overdose on painkillers, mostly oxycodone, an artificial form of heroin. Yet, oxycodone is not banned; not only is it not banned, but it's actively pushed in literally hundreds of "pain management" mills in Florida, most of them in Broward County. Yet, with only a handful of deaths attributed to it, ma huang (Herba Ephedra) is banned for use.
I should point out that I do support the banning of ephedra from supplements and other forms of snake oil. Manufacturers of these supplements are abusing a substance in a way never intended. Contraindications for ma huang in the Chinese medical literature clearly state that dose and duration of it should be limited, as it has a tendency to plunder yin if taken too long. However, as was observed a long time ago, Americans have a tendency to take any kind of hokum-in-a-bottle and ingest it, if it promises happiness, a slender figure, and health. Knowing this, supplement makers will go ahead and abuse medicinals like ma huang, and chen pi (Pericarpium citri reticulatae), if they can make a buck on it. The net result is to make life hard for those of us who have studied these herbs and use them in the way that they're supposed to be used. As a weight loss supplement, ma huang is a terrible idea. As a medicinal, in the right situations, it works almost miraculously. The fact that supplement makers are systematically putting more and more of the Chinese pharmaecopia out of reach is outrageous.
More outrageous is the fact that pain management mills in Florida, the Pusher State, can dispense tons of painkillers, hooking thousands of their fellow countrymen, destroying lives, and that they can do so legally. The problem goes beyond Florida, as well. As was pointed out on Vanguard, the impact is felt as far away as Ohio, as more and more citizens make the pilgrimage to Florida to get their OxyContin fix. In Greenup County, Kentucky, 90 percent, that's 90 percent, of people in jail now are in due to oxycodone related crime; either trafficking in it, stealing to pay for it, or theft of it. There isn't a family in the county (and, I'm betting, the state) that hasn't been negatively affected by oxycodone and its use and abuse. Yet, the FDA has chosen to ban ephedra (and will probably ban other herbs as they become the next season's brand of supplement snake oil) rather than oxycodone and other painkillers.
I should also take this opportunity to point out to all medical doctors who say that we in acupuncture are quacks to take a good look at your colleagues down in God's Waiting Room, and at the damage they're doing. If it waddles like a duck, and makes a distinct sound like a duck...
As an acupuncturist that works in a harm reduction clinic, I should also point out that I have a lot of patients coming to me for pain. Most of them are addicts trying to get their lives together. Usually, they come to me for help with pain because they themselves are afraid of oxycodone, and have explicitly told me so. If former heroin users are afraid to go near it, then everyone else should be terrified of the stuff.
Wednesday, October 14, 2009
Crazy Heat
Working at SACHR, I see a lot of patients that have hepatitis, or that have HIV. Recently, I just began treating a woman with both. She has hep A and C, HIV, and diabetes. Heat is the byword for this woman. Her pulse is rapid and thin, and her tongue is scarlet. She has, perhaps, the first truly scarlet tongue I've seen without the aid of hard candy.
Her hepatitis has given her hepatomegaly, and she has a hard time breathing due to crowding of the abdomen. She also has lots of phlegm. While not jaundiced, her skin does have heat papules covering her upper chest, which makes sense since heat rises.
So far, I've only been giving her palliative acupuncture. Her last treatment focused on trying to clear some of her heat. Liver 2 was a prime point, and she also received Kidney 6, L.I. 11, Pc 7, and Stomach 40 for phlegm. I also used GB 41 to move some of her Liver qi.
I intend to follow up with this patient intently, and am currently waiting for her doctor to send me her Liver work-up. More to follow.
Speaking of heat, sometimes a little bit of knowledge is indeed a bad thing. Another of my patients at SACHR has been coming regularly to me for about two weeks, and has loads of heat in him. This patient is actually quite robust. Just two days ago, when he thought I was in the treatment Sanctuary, but wasn't, he tried to open the door. He twisted the locked door-knob with such force that he destroyed it. So far, he has almost always presented with a red tongue, especially near the tip and front, with a dry yellow coat. He has a lot of hunger, and is thirsty a lot. He also suffers from gastritis. He almost always presents with a sweat, staining his clothes.
This case drove me crazy, as I would give treatments to clear heat, and nothing I did seemed to work. The last three treatments have focused on clearing heat from the ying/nutritive level; although not delirious, he does have some history of mental illness (currently under control). Points that I used were Pc 8, Sp 10, L.I. 11, Heart 3, and Pc 7. At times, there would be a slight improvement, but nothing substantial.
Today, however, as he was getting ready to leave, he let slip a vital piece of information that he hadn't told me before. He was regularly taking ren shen (Radix ginseng)! Not just regularly, but daily, both Chinese and Korean varieties! Suddenly, it all made sense. I'd clear heat, and then he'd go and put it right back in. I don't blame the patient; I blame marketing. Drink makers and marketers have been touting the wonderful effects of ginseng and you can even find it in neighborhood bodegas. As wonderful an herb as ginseng is, like the saying says, too much of a good thing is a bad thing. What's worse is that this is precisely the kind of abuse of herbs, in ways that the compilers of all Chinese materia medica never dreamed of in their darkest nightmares, gets herbs banned from the market in this country. The latest casualty in this country is ma huang (Hb. ephedra). It's impossible to get, all because Orioles pitcher Steve Belcher abused ephedra and inadvertently killed himself. I say abused ephedra, although I'm sure he and thousands of people like him didn't think they were abusing it. After all, the makers of diet pills were putting it in their product, and they wouldn't do anything to harm you to make a buck, would they?
Bottom line: more people across the USA abuse oxycontin than abuse heroin, cocaine, and alcohol combined, but it's still prescribed legally. One ill-informed athlete uses ephedra in a way never intended in any Chinese medical text, in a manner that flouted all the traditional contraindications, and winds up killing himself, and suddenly it's too risky, nope, sorry, training or not, you can't have it. There's something very wrong with this picture.
Her hepatitis has given her hepatomegaly, and she has a hard time breathing due to crowding of the abdomen. She also has lots of phlegm. While not jaundiced, her skin does have heat papules covering her upper chest, which makes sense since heat rises.
So far, I've only been giving her palliative acupuncture. Her last treatment focused on trying to clear some of her heat. Liver 2 was a prime point, and she also received Kidney 6, L.I. 11, Pc 7, and Stomach 40 for phlegm. I also used GB 41 to move some of her Liver qi.
I intend to follow up with this patient intently, and am currently waiting for her doctor to send me her Liver work-up. More to follow.
Speaking of heat, sometimes a little bit of knowledge is indeed a bad thing. Another of my patients at SACHR has been coming regularly to me for about two weeks, and has loads of heat in him. This patient is actually quite robust. Just two days ago, when he thought I was in the treatment Sanctuary, but wasn't, he tried to open the door. He twisted the locked door-knob with such force that he destroyed it. So far, he has almost always presented with a red tongue, especially near the tip and front, with a dry yellow coat. He has a lot of hunger, and is thirsty a lot. He also suffers from gastritis. He almost always presents with a sweat, staining his clothes.
This case drove me crazy, as I would give treatments to clear heat, and nothing I did seemed to work. The last three treatments have focused on clearing heat from the ying/nutritive level; although not delirious, he does have some history of mental illness (currently under control). Points that I used were Pc 8, Sp 10, L.I. 11, Heart 3, and Pc 7. At times, there would be a slight improvement, but nothing substantial.
Today, however, as he was getting ready to leave, he let slip a vital piece of information that he hadn't told me before. He was regularly taking ren shen (Radix ginseng)! Not just regularly, but daily, both Chinese and Korean varieties! Suddenly, it all made sense. I'd clear heat, and then he'd go and put it right back in. I don't blame the patient; I blame marketing. Drink makers and marketers have been touting the wonderful effects of ginseng and you can even find it in neighborhood bodegas. As wonderful an herb as ginseng is, like the saying says, too much of a good thing is a bad thing. What's worse is that this is precisely the kind of abuse of herbs, in ways that the compilers of all Chinese materia medica never dreamed of in their darkest nightmares, gets herbs banned from the market in this country. The latest casualty in this country is ma huang (Hb. ephedra). It's impossible to get, all because Orioles pitcher Steve Belcher abused ephedra and inadvertently killed himself. I say abused ephedra, although I'm sure he and thousands of people like him didn't think they were abusing it. After all, the makers of diet pills were putting it in their product, and they wouldn't do anything to harm you to make a buck, would they?
Bottom line: more people across the USA abuse oxycontin than abuse heroin, cocaine, and alcohol combined, but it's still prescribed legally. One ill-informed athlete uses ephedra in a way never intended in any Chinese medical text, in a manner that flouted all the traditional contraindications, and winds up killing himself, and suddenly it's too risky, nope, sorry, training or not, you can't have it. There's something very wrong with this picture.
Thursday, July 23, 2009
Heat, Wind, and Fire
A private patient of mine has had psoriasis for the last ten years. I particularly like this patient, because although he's an organic chemist, and despite the fact that it was his job to make pharmaceuticals, he has a keen interest in herbs and actually studied Western herbalism for a number of years. Highly intelligent and open to other things, he didn't allow his Western science training to blunt his curiosity to and openness to other modalities. Which, of course, goes without saying, since he's my patient. He's also a long-time taijiquan practitioner, which is how I know him. We both attend the same push-hands club.
As I mentioned, he's had psoriasis for the last ten years, and with the application of herbal liniments, has managed to keep it in check for some time. However, it had been flaring up recently, and so he sought treatment from me.
During the intake, it became apparent that there was a lot going on. In the last few years, he's lost 25 lbs., having gone from 140 to about 115. Already thin, this made him look fairly gaunt. His sleep has been terrible, although with a mixture of Ambien and melatonin he was able to get some sleep. He had been using Valerian to help this, but it eventually lost its efficacy. More on sleep later.
Bowel movements are unremarkable, as he goes once a day. However, he does try to stay hydrated, and always has water on hand. Despite his remarkable weight loss, he's not particularly hungry. He merely grazes throughout the day. He did mention that he can't eat the same foods he used to eat and enjoy, a prime example being corn chips. He used to enjoy them, but now they produce an uncomfortable feeling in his stomach.
Memory has been poor, and his limbs easily fall asleep. Finger and toe-nails are dull, cracked and in some instances peeling away from the nail bed (this last is confined to the toes).
Most remarkable has been his pulse. It's flooding and forceful, with a floating quality, especially in the guan positions. It has also been extremely rapid: one time, topping out at 105 bpm. This is practically tachycardia, and is indicative of raging heat. While lying on the table, he even feels hot, with his skin practically radiating heat.
Given all that, you'd think his psoriasis would be out of control, but it's primarily confined to his left elbow, and a small patch on his low back. He is afraid that he may be getting psoriatic arthritis, and his joints do pop dramatically at times.
His tongue is almost normal, with a thin white coat, but with red, peeled edges and tip.
One of the first differential diagnoses I thought of was diabetes, but he doesn't truly exhibit the triad of polyphagia, polydypsia, or polyuria. Hyperthyroid is a distinct possibility, but currently, he's between jobs and doesn't have health insurance (Congressional Republicans, are you listening?). As a result, he hasn't been to the doctor in a year.
TCM pattern diagnosis was Liver Blood Deficiency leading to Wind in the skin. There is also Liver and Heart heat (if not outright Fire) which is leading to Yin deficiency (especially of the Stomach, which is why he's finding it difficult to eat). I've found the warnings of my teachers to be true: it's turning out to be a difficult case to treat.
My first concern was to drain Fire, and then to boost Blood. For points, I followed the protocol of Yan Wu:
Initially, I followed the dosages of the individual herbs in this formula as given by Bensky in his Strategies and Formulas:
On his last visit, I was elated to find that his pulse rate had dropped to 82 bpm, and that he had gained 2 lbs, both positive changes. Also, while away in Massachussetts, he cheated on his gluten-free diet, yet didn't suffer any ill effects, nor experience a psoriasis flare-up. Currently, he's still undergoing treatment and taking his herbs. We decided that when he doesn't have to be anywhere the next day, to leave off the Ambien and simply take the herbs, to see what happens. I look forward to seeing and noting any future progress.
As I mentioned, he's had psoriasis for the last ten years, and with the application of herbal liniments, has managed to keep it in check for some time. However, it had been flaring up recently, and so he sought treatment from me.
During the intake, it became apparent that there was a lot going on. In the last few years, he's lost 25 lbs., having gone from 140 to about 115. Already thin, this made him look fairly gaunt. His sleep has been terrible, although with a mixture of Ambien and melatonin he was able to get some sleep. He had been using Valerian to help this, but it eventually lost its efficacy. More on sleep later.
Bowel movements are unremarkable, as he goes once a day. However, he does try to stay hydrated, and always has water on hand. Despite his remarkable weight loss, he's not particularly hungry. He merely grazes throughout the day. He did mention that he can't eat the same foods he used to eat and enjoy, a prime example being corn chips. He used to enjoy them, but now they produce an uncomfortable feeling in his stomach.
Memory has been poor, and his limbs easily fall asleep. Finger and toe-nails are dull, cracked and in some instances peeling away from the nail bed (this last is confined to the toes).
Most remarkable has been his pulse. It's flooding and forceful, with a floating quality, especially in the guan positions. It has also been extremely rapid: one time, topping out at 105 bpm. This is practically tachycardia, and is indicative of raging heat. While lying on the table, he even feels hot, with his skin practically radiating heat.
Given all that, you'd think his psoriasis would be out of control, but it's primarily confined to his left elbow, and a small patch on his low back. He is afraid that he may be getting psoriatic arthritis, and his joints do pop dramatically at times.
His tongue is almost normal, with a thin white coat, but with red, peeled edges and tip.
One of the first differential diagnoses I thought of was diabetes, but he doesn't truly exhibit the triad of polyphagia, polydypsia, or polyuria. Hyperthyroid is a distinct possibility, but currently, he's between jobs and doesn't have health insurance (Congressional Republicans, are you listening?). As a result, he hasn't been to the doctor in a year.
TCM pattern diagnosis was Liver Blood Deficiency leading to Wind in the skin. There is also Liver and Heart heat (if not outright Fire) which is leading to Yin deficiency (especially of the Stomach, which is why he's finding it difficult to eat). I've found the warnings of my teachers to be true: it's turning out to be a difficult case to treat.
My first concern was to drain Fire, and then to boost Blood. For points, I followed the protocol of Yan Wu:
- Qu Chi Large Intestine 11: Excellent for all heat conditions and especially good for skin conditions.
- Xue Hai Spleen 10: To invigorate the Blood. Also an excellent point for itch.
- San Yin Jiao Spleen 6: The meeting place of the three leg-yin channels, to help tonify Yin in general.
- Ge Shu Urinary Bladder 17: The Diaphragm Back-Shu point, and the Meeting Point of Blood. Crucial for any Blood pathology. I also add Dan Shu UB 19, to activate the "Four Flowers."
- Zu San Li Stomach 36. Pre-eminent point for building qi and Blood. I also like to add with this point Shou San Li Large Intestine 10, a favorite combo of one of my teachers.
- Tai Xi Kidney 3 and Qu Quan Liver 8: another good Blood building combo.
- Zu Lin Qi Gall Bladder 41, to move stagnant qi. Sometimes, I'll use this on one foot, and on the other Di Wu Hui GB 42 to clear GB channel heat.
- Xin Shu UB 15 to clear Heart Heat and calm the Spirit. This works well with Shen Dao Du 11.
- Da Zhui Du 14, to clear heat.
Initially, I followed the dosages of the individual herbs in this formula as given by Bensky in his Strategies and Formulas:
- Radix Rehmanniae Glutinosae (sheng di huang) 9g
- Radix Angelicae Sinensis (dang gui) 6g
- Hb. seu Flos Schizonepetae (jing jie) 4.5g
- Rx. Ledibouriella Saposhnikoviae (fang feng) 4.5g
- Rx. Paeoniae Rubrae (chuan xiong) 3g
- Rx. Ligustici (chuan xiong) 3g
- Cx. Dictamni Dasycarpi (bai xian pi) 3g
- Periosctracum Cicadae (chan tui) 3g
- Hb. Menthae Haplocalycis (bo he) 3g
- Rx. Angelicae Pubescentis (du huo) 2.1g
- Rx. Bupleuri (chai hu) 2.1g
- Fr. Zizyphi Jujubae (da zao) 2 pcs
- Cx. Moutan Radicis (mu dan pi) 6g
- Cx. Lycii (di gu pi) 6g
- Concha Margarita (zhen zhu mu) 30g
- Fr. Schisandrae (wu wei zi) 6g
- Caulis Polygoni Multiflori (ye jiao teng) 30g
On his last visit, I was elated to find that his pulse rate had dropped to 82 bpm, and that he had gained 2 lbs, both positive changes. Also, while away in Massachussetts, he cheated on his gluten-free diet, yet didn't suffer any ill effects, nor experience a psoriasis flare-up. Currently, he's still undergoing treatment and taking his herbs. We decided that when he doesn't have to be anywhere the next day, to leave off the Ambien and simply take the herbs, to see what happens. I look forward to seeing and noting any future progress.
Friday, July 3, 2009
Chemo Side Effects
One of my new patients today was a fifty year old woman undergoing chemotherapy. She asked to be treated for the side effects of the chemo, and had already had a bout of it today. She reports that the effects don't hit her right away, but that by this evening, she would have aching limbs, a frontal headache, runny nose, and nausea. She reported that she had had some nausea earlier, but had eaten some bread and that calmed her stomach.
The woman herself is overweight, but has no other complaints aside from the cancer and chemo. Her pulses were fine, soft in the cun positions, and slippery. Her chi positions were somewhat deep as well.
Her tongue was extremely scalloped, with a thick but patchy, greasy coat, and a red body. Some spots of her tongue coat were yellow, others seemed whiter.
Her pattern I decided was one of Dampness and Phlegm in the Middle jiao, with some Qi and Blood deficiency. Points used were:
The woman herself is overweight, but has no other complaints aside from the cancer and chemo. Her pulses were fine, soft in the cun positions, and slippery. Her chi positions were somewhat deep as well.
Her tongue was extremely scalloped, with a thick but patchy, greasy coat, and a red body. Some spots of her tongue coat were yellow, others seemed whiter.
Her pattern I decided was one of Dampness and Phlegm in the Middle jiao, with some Qi and Blood deficiency. Points used were:
- Shousanli LI 10: To augment Qi and Blood, along with Zusanli Stomach 36.
- Zusanli St 36: To augment Qi and Blood. According to Deadman, this point is also good for relieving Fire, and as she has some component of heat, it's doubly useful in her case.
- Neiguan Pc 6: Since the Pericardium channel goes to the Middle Jiao, this point is useful for nausea, and can harmonize the Stomach, and regulate Blood.
- Hegu LI 4: I used this for her frontal headache and nasal problems, as this is the Command point of the face.
- Fenglong St 40: For Phlegm and Dampness.
- Yintang: To help calm her mind.
- Sanyinjiao Spleen 6: This tonifies the Spleen and Stomach and also helps resolve Damp. It also harmonizes the Liver and Lower Jiao.
- Zulinqi GB 41: To resolve Damp-Heat.
Addiction and Depression
My latest patient came to me to help halt an uptick in his crack-cocaine usage. There is a lot there, and I earnestly hope that I can help.
The patient is a young man, 29, and gay. His father was the first person to introduce him to drugs, starting with marijuana. In talking, he noted that he had some anger, and a feeling of not being rooted. With life so meaningless, why be clean?
Pulse was somewhat floating, also wiry. Heart rate was normal. His tongue was long, with the center bulged up and flat sides. Coat was thin, even, and white.
This young man is relatively fit, and doesn't look the part of a crack-head. He speaks calmly and almost reflectively, wondering during his intake about why someone would give his child marijuana, about life, about why he would follow his father in using drugs. For one year and a half, he said he was clean, despite working in nightclubs; he could work there, and not smoke, drink, or imbibe any substances.
For me, the questioning revolved around looking for what was different about that year and a half. Feeling more rooted seems to have been part of it, as he was involved in a relationship for some of that time, although in the end, it didn't work out, and he said he knew it wouldn't.
For an opening treatment, I focused on calming his mind, and moving qi. Points selected were:
The patient is a young man, 29, and gay. His father was the first person to introduce him to drugs, starting with marijuana. In talking, he noted that he had some anger, and a feeling of not being rooted. With life so meaningless, why be clean?
Pulse was somewhat floating, also wiry. Heart rate was normal. His tongue was long, with the center bulged up and flat sides. Coat was thin, even, and white.
This young man is relatively fit, and doesn't look the part of a crack-head. He speaks calmly and almost reflectively, wondering during his intake about why someone would give his child marijuana, about life, about why he would follow his father in using drugs. For one year and a half, he said he was clean, despite working in nightclubs; he could work there, and not smoke, drink, or imbibe any substances.
For me, the questioning revolved around looking for what was different about that year and a half. Feeling more rooted seems to have been part of it, as he was involved in a relationship for some of that time, although in the end, it didn't work out, and he said he knew it wouldn't.
For an opening treatment, I focused on calming his mind, and moving qi. Points selected were:
- Shencang Kid 25: To help calm the mind.
- Buddha's Triangle, both arms: this consists of Taiyuan Lung 9, Neiguan Pc 6, and Shenmen Heart 7. Especially good for calming the spirit.
- Sanyinjiao Spleen 6: To also calm the mind, Harmonize the Liver, and move blood.
- Zulinqi GB 41: I find this point indispensable for treating addicts, no matter the pattern. It strongly moves Liver qi.
Saturday, June 13, 2009
Water Swelling Follow-up
My patient with the back pain and the water swelling has returned several times to see me, and has improved each time. However, she still seems pretty exhausted when she comes in, and nothing I do can replace some good rest.
Still, I'm happy to say that the swelling in her legs has decreased, and that the angry looking varicose veins that displayed have toned down considerably. Her tongue still has a thin, yellow coat, but the body color is a more normal pale-red than before. It's not quite as puffy, nor are there any scallops.
She has become a huge fan of moxa (as have I), and practically demands its use when she comes in. I always use moxa with her on Du 4. The last time I saw her, I also used a brass moxa burner with a handle on it to move up and down her UB channels on her back. It's the first time I've used one on any patient (although I have used moxa boxes, but that's stationary).
She showed some signs of qi deficiency and complained of neck pain last time I saw her, so, aside from moxa at Du4, I also needled the following points: UB13, 17, 19, 40, 39, 60; Kidney 3, and luozhen. After treatment, she showed considerably more energy. Of course, this could purely be from getting a good rest, as I usually retain needles in her for a good 30 minutes, and let her sleep during that time. However, she continues to show signs of improvement overall.
If I had my druthers, I'd prescribe for her zhen wu tang. However, herbs aren't prescribed at SACHR, so this will have to wait for now.
Still, I'm happy to say that the swelling in her legs has decreased, and that the angry looking varicose veins that displayed have toned down considerably. Her tongue still has a thin, yellow coat, but the body color is a more normal pale-red than before. It's not quite as puffy, nor are there any scallops.
She has become a huge fan of moxa (as have I), and practically demands its use when she comes in. I always use moxa with her on Du 4. The last time I saw her, I also used a brass moxa burner with a handle on it to move up and down her UB channels on her back. It's the first time I've used one on any patient (although I have used moxa boxes, but that's stationary).
She showed some signs of qi deficiency and complained of neck pain last time I saw her, so, aside from moxa at Du4, I also needled the following points: UB13, 17, 19, 40, 39, 60; Kidney 3, and luozhen. After treatment, she showed considerably more energy. Of course, this could purely be from getting a good rest, as I usually retain needles in her for a good 30 minutes, and let her sleep during that time. However, she continues to show signs of improvement overall.
If I had my druthers, I'd prescribe for her zhen wu tang. However, herbs aren't prescribed at SACHR, so this will have to wait for now.
Tuesday, June 9, 2009
One Point Wonder
Sometimes, at SACHR, time gets very tight, what with giving full conventional treatments, and helping with NADA protocol in the Sanctuary. Case in point: A young woman asked for full body treatment for back pain. She said she has a scoliosis, and that her low back gets painful. However, she had to be at a women's meeting at 2:00 pm, and she had to fill out the requisite paperwork and consent forms before I could treat her. The time was 1:40, not enough. So, I let her fill out the paperwork, gave her ear-seeds for NADA, and then gave her what I called a "quick and dirty" back treatment.
After she filled out the forms (which I filed for later use), I asked which direction hurt her the most to turn toward. She indicated that rotating her waist to her right was more painful. I therefore used extra point yaotongxue, on the dorsum of her left hand. Yaotongxue is actually two points, just distal to the carpal bones, between the 2nd and 3rd, and the 4th and 5th metacarpal bones. For her, the one between the 4th and 5th metacarpals was the more painful.
I stimulated the needle at that point, by rotating it with draining, while she rotated her waist left and right. After five minutes, she said the pain was gone. I retained the needle for five more minutes, every so often stimulating it, then removed both needles. The pain was completely gone, and she was able to go to her women's meeting pain free.
After she filled out the forms (which I filed for later use), I asked which direction hurt her the most to turn toward. She indicated that rotating her waist to her right was more painful. I therefore used extra point yaotongxue, on the dorsum of her left hand. Yaotongxue is actually two points, just distal to the carpal bones, between the 2nd and 3rd, and the 4th and 5th metacarpal bones. For her, the one between the 4th and 5th metacarpals was the more painful.
I stimulated the needle at that point, by rotating it with draining, while she rotated her waist left and right. After five minutes, she said the pain was gone. I retained the needle for five more minutes, every so often stimulating it, then removed both needles. The pain was completely gone, and she was able to go to her women's meeting pain free.
Sunday, June 7, 2009
Acupuncturist, Heal Thyself
In the course of getting our degrees in TCM, we're all told about the dangers of exposing ourselves to exogenous pathogenic factors, particularly wind. So, what do I do? With some hint of wind signs already (itchy nose), I rode my bicycle to work in cool weather, with just short sleeve jersey and shorts. Come the next day, I had a nice wind cold.
Symptoms were fairly typical of wind strike. Weak sweat, achy neck, stuffed up nose, no particular thirst. Now, in hindsight, it seems fairly obvious that the appropriate formula would have been gui zhi tang (Cinnamon Twig Formula). Naturally, I didn't do that. Cognizant of some of my own internal deficiencies (blood deficiency, particularly) I took ren shen bai du san (Ginseng Powder to Overcome Pathogenic Influences). Whenever I took it, I would feel better, but then start to feel ill again a few hours later. So, either the formula was incorrect, or I wasn't taking a big enough dose.
After two days, wanting to get some sleep and not lie in bed blowing my nose, I took Nyquil. Big mistake. I slept okay, but woke up feeling far worse, with the same symptoms, and now with a congested chest. At this point, I stopped taking the ren shen bai du san, as it was now really inappropriate. I found myself wishing for some xiao qing long tang (Minor Blue-Green Dragon Formula). Too bad I couldn't get any. I just waited it out the old fashioned way, drinking plenty of fluids and teas, and sleeping.
As of this writing, I'm pretty much recovered, although still coughing up phlegm. By tomorrow, I'll be pretty much normal. But, from now on, I'll be more discriminating in what I prescribe for myself.
Symptoms were fairly typical of wind strike. Weak sweat, achy neck, stuffed up nose, no particular thirst. Now, in hindsight, it seems fairly obvious that the appropriate formula would have been gui zhi tang (Cinnamon Twig Formula). Naturally, I didn't do that. Cognizant of some of my own internal deficiencies (blood deficiency, particularly) I took ren shen bai du san (Ginseng Powder to Overcome Pathogenic Influences). Whenever I took it, I would feel better, but then start to feel ill again a few hours later. So, either the formula was incorrect, or I wasn't taking a big enough dose.
After two days, wanting to get some sleep and not lie in bed blowing my nose, I took Nyquil. Big mistake. I slept okay, but woke up feeling far worse, with the same symptoms, and now with a congested chest. At this point, I stopped taking the ren shen bai du san, as it was now really inappropriate. I found myself wishing for some xiao qing long tang (Minor Blue-Green Dragon Formula). Too bad I couldn't get any. I just waited it out the old fashioned way, drinking plenty of fluids and teas, and sleeping.
As of this writing, I'm pretty much recovered, although still coughing up phlegm. By tomorrow, I'll be pretty much normal. But, from now on, I'll be more discriminating in what I prescribe for myself.
Thursday, May 21, 2009
Back Pain and Water Swelling.
Today's patient was quite interesting. A worker at SACHR, she presented with back and neck pain. So, I figured maybe a standard protocol for her, but her case turned out to be unstandard. Her limbs had definite signs of edema, with her legs showing non-pitting edema. Aside from bad low back and neck pain, she also said that she lives in the bathroom (to urinate). She also suffers from constipation, moving bowels only every 3-4 days. She suffered from nightmares, and then she was too afraid to go back to sleep. She had pain in her limbs as well. She reported that she often ran cold.
This patient definitely had signs of Kidney Yang deficiency, with deranged water metabolism. Her tongue didn't quite match. It was broad, pale, but with a dry yellow coat. However, she smokes roughly half-a-pack a day. Her pulses were relatively deep, slippery, and soft.
For this patient, I decided to focus on her back pain, and only obliquely address the water issues. Luckily, they overlap somewhat, since the Kidney Yang deficiency has a role in both. Points used were: UB 10, 13, 15, 23, 39, 40, 58, and 60. Other points were Lung 7, L.I. 4, Kidney 3, and Du 9. UB 10, 23, 40, 58, and 60 address her back problems, especially 10 and 40, while the other points help to strengthen the Organs responsible for water metabolism. Lung 7 and UB 13 for the upper source of water, the Lungs, L.I. 4 to help the L.I. with water absorption, UB 39 to help rectify the San Jiao, the minister of the water passages, and Kidney 3 with UB 23 to tonify the Kidneys, which dominate water. Du 9 is also useful for this, as fortifies the Spleen, drains dampness and strengthens the middle jiao. I added UB 15 to help regulate her Heart qi and ease her nightmares.
Pole moxa was applied to Du 4 Mingmen for ten minutes, to help boost Kidney Yang, further helping regulate water metabolism and relieve lower back pain.
The patient fell asleep on the table practically from the first needle, a sign that she was really sleep deprived. I retained the needles for 30 minutes, purely to let her sleep as long as possible. After withdrawing the needles, and waking her up, the patient was much refreshed. Her shen/disposition was vastly improved, she was more energetic, and she even bent over to tie her shoes, something she said she never did. I should be seeing her tomorrow as well. Hopefully, her other symptoms should have eased as well.
This patient definitely had signs of Kidney Yang deficiency, with deranged water metabolism. Her tongue didn't quite match. It was broad, pale, but with a dry yellow coat. However, she smokes roughly half-a-pack a day. Her pulses were relatively deep, slippery, and soft.
For this patient, I decided to focus on her back pain, and only obliquely address the water issues. Luckily, they overlap somewhat, since the Kidney Yang deficiency has a role in both. Points used were: UB 10, 13, 15, 23, 39, 40, 58, and 60. Other points were Lung 7, L.I. 4, Kidney 3, and Du 9. UB 10, 23, 40, 58, and 60 address her back problems, especially 10 and 40, while the other points help to strengthen the Organs responsible for water metabolism. Lung 7 and UB 13 for the upper source of water, the Lungs, L.I. 4 to help the L.I. with water absorption, UB 39 to help rectify the San Jiao, the minister of the water passages, and Kidney 3 with UB 23 to tonify the Kidneys, which dominate water. Du 9 is also useful for this, as fortifies the Spleen, drains dampness and strengthens the middle jiao. I added UB 15 to help regulate her Heart qi and ease her nightmares.
Pole moxa was applied to Du 4 Mingmen for ten minutes, to help boost Kidney Yang, further helping regulate water metabolism and relieve lower back pain.
The patient fell asleep on the table practically from the first needle, a sign that she was really sleep deprived. I retained the needles for 30 minutes, purely to let her sleep as long as possible. After withdrawing the needles, and waking her up, the patient was much refreshed. Her shen/disposition was vastly improved, she was more energetic, and she even bent over to tie her shoes, something she said she never did. I should be seeing her tomorrow as well. Hopefully, her other symptoms should have eased as well.
Tuesday, May 19, 2009
Migraine and GB channel fire.
Yesterday, had my first "emergency" case. As I was getting ready to treat a patient, SACHR's director made an appointment for someone she said was suffering from migraine. When the guy came in, I could see that "suffering" was a bit of an understatement. He was in agony. His eyes were tight shut against the light, and he was starting to curl around his chest. The pain was also affecting his breathing.
The pain was right behind his left eye-ball, and was intense. He also indicated the left side of his head. Speech was very slow and labored. His pulses were rapid, and bounding, indicating exuberant heat.
In my experience with drug users, there is often a surfeit of Liver/GB channel fire. The drugs they take directly affect the Liver. The drugs move qi for a little bit, but then the qi stagnates rapidly after. The constant cycle of moving and then stagnating qi heats the Liver. If they also drink, and most do, the alcohol damp-heat further insults the Liver. Eventually, that heat has to go somewhere, and it usually ends up in the GB channel. Usually, treating the GB channel goes a long way to soothing and smoothing a user's qi.
With this person, I felt I had to act quickly, so I didn't bother placing him on a table, but treated him where he sat. I needled GB 20 and GB 43 bilaterally with draining. GB 20 to unconstrain the qi in his head, and GB 43 to descend GB channel fire, which was essential. Within 2 minutes, the pain had diminished, and he was able to open his eyes somewhat, but not entirely. He also appeared more relaxed, and he had uncurled from around his chest. I retained the needles for about 20 minutes.
After removing the needles I sat him down on a low chair, and did tui na on his GB 21 area, including pushing, grasping, kneading and dredging GB 21 as well as SI 11, and beating along the traps. I also round-rubbed up along the medial border of the scapula, up into GB 20 again. The area around GB 21 was very tight, indicating a lot of stagnation of GB channel qi. After finishing the tui na treatment, the patient was able to completely open his eyes, and he said the pain was completely gone.
For someone like this, Longdan Xie Gan Tang would be ideal, but no one at sachr can afford herbs. Points like GB 43 and GB 34, which clears Liver/GB damp-heat, also work well. For someone who isn't in such extremis, I also like to use GB 41 a lot to help clear the head and spread Liver qi.
The pain was right behind his left eye-ball, and was intense. He also indicated the left side of his head. Speech was very slow and labored. His pulses were rapid, and bounding, indicating exuberant heat.
In my experience with drug users, there is often a surfeit of Liver/GB channel fire. The drugs they take directly affect the Liver. The drugs move qi for a little bit, but then the qi stagnates rapidly after. The constant cycle of moving and then stagnating qi heats the Liver. If they also drink, and most do, the alcohol damp-heat further insults the Liver. Eventually, that heat has to go somewhere, and it usually ends up in the GB channel. Usually, treating the GB channel goes a long way to soothing and smoothing a user's qi.
With this person, I felt I had to act quickly, so I didn't bother placing him on a table, but treated him where he sat. I needled GB 20 and GB 43 bilaterally with draining. GB 20 to unconstrain the qi in his head, and GB 43 to descend GB channel fire, which was essential. Within 2 minutes, the pain had diminished, and he was able to open his eyes somewhat, but not entirely. He also appeared more relaxed, and he had uncurled from around his chest. I retained the needles for about 20 minutes.
After removing the needles I sat him down on a low chair, and did tui na on his GB 21 area, including pushing, grasping, kneading and dredging GB 21 as well as SI 11, and beating along the traps. I also round-rubbed up along the medial border of the scapula, up into GB 20 again. The area around GB 21 was very tight, indicating a lot of stagnation of GB channel qi. After finishing the tui na treatment, the patient was able to completely open his eyes, and he said the pain was completely gone.
For someone like this, Longdan Xie Gan Tang would be ideal, but no one at sachr can afford herbs. Points like GB 43 and GB 34, which clears Liver/GB damp-heat, also work well. For someone who isn't in such extremis, I also like to use GB 41 a lot to help clear the head and spread Liver qi.
Monday, May 18, 2009
Being at St. Ann's.
Well, since May 4th, I have been working as acupuncturist at St. Ann's Corner of Harm Reduction (SACHR). For those not familiar with the term, "harm reduction," it's a way of dealing with drug addicts that doesn't necessarily try to get them to stop drugs, but minimize the harm they do to themselves and others. SACHR started in the trunk of the director's car, as a needle exchange. Joyce Rivera's goal was to lower the prevalence of HIV in the Bronx. She succeeded. Joyce and her staff were able to reduce the prevalence from 69% to 11%.
Since then, SACHR has outgrown her car's trunk. Now located at 310 Walton Avenue, SACHR gives counseling, provides food, and offers some training for people that a lot of New Yorker's hipster crowd would rather not be near.
Treating such a population is challenging. SACHR does provide the National Acupuncture Detoxification Association (NADA) ear acupuncture protocol, and a meditative "sanctuary" for the patients to rest in during treatment. I was brought on board to provide full treatment, as needed (as were two other acupuncturists). Not everyone understands that there's a difference between the NADA protocol and regular acupuncture, and I have to explain a lot to people who've never been exposed to it. One thing is certain: these people really need it. My very first patient saw me for shoulder pain, but had a laundry list of injuries and ailments; bullets still lodged close to the spine, hep C, on top of his addiction. While taking his pulse, I noticed that his Lung pulse (right cun position) was very depressed, and I asked if he had any respiratory problems. He answered that he was missing a lung, as a result of gunfire.
If anyone is interested in St. Ann's, either to make a donation or to volunteer, please look it up at www.sachr.org.
-Rob
Since then, SACHR has outgrown her car's trunk. Now located at 310 Walton Avenue, SACHR gives counseling, provides food, and offers some training for people that a lot of New Yorker's hipster crowd would rather not be near.
Treating such a population is challenging. SACHR does provide the National Acupuncture Detoxification Association (NADA) ear acupuncture protocol, and a meditative "sanctuary" for the patients to rest in during treatment. I was brought on board to provide full treatment, as needed (as were two other acupuncturists). Not everyone understands that there's a difference between the NADA protocol and regular acupuncture, and I have to explain a lot to people who've never been exposed to it. One thing is certain: these people really need it. My very first patient saw me for shoulder pain, but had a laundry list of injuries and ailments; bullets still lodged close to the spine, hep C, on top of his addiction. While taking his pulse, I noticed that his Lung pulse (right cun position) was very depressed, and I asked if he had any respiratory problems. He answered that he was missing a lung, as a result of gunfire.
If anyone is interested in St. Ann's, either to make a donation or to volunteer, please look it up at www.sachr.org.
-Rob
Tuesday, April 14, 2009
Newly Minted; Get the Breath Mints!
Wow, it's finally happened! After six years of schooling (much of it while working), and a lot of sweat, blood, and a considerable amount of tears, I am finally a licensed acupuncturist in the State of New York.
What's funny about going through School for Traditional Chinese Medicine (TCM) is that you can start to identify many of the syndromes you're learning about because you come down with so many of them thanks go school for TCM. Liver qi stagnation, Spleen and Blood deficiency, Dian-Kuang (mania-withdrawal). Yep, did that, had that, and was soooo that last one!
But, after lotsa money in loans, an eviction, and assorted other challenges, I finally have license in hand.
Hopefully, in the years to come, I'll be able to journal some cases I'm working on (no names, ever) and some observations about health in general. As ever, I look for any feedback I can get.
Cheers!
What's funny about going through School for Traditional Chinese Medicine (TCM) is that you can start to identify many of the syndromes you're learning about because you come down with so many of them thanks go school for TCM. Liver qi stagnation, Spleen and Blood deficiency, Dian-Kuang (mania-withdrawal). Yep, did that, had that, and was soooo that last one!
But, after lotsa money in loans, an eviction, and assorted other challenges, I finally have license in hand.
Hopefully, in the years to come, I'll be able to journal some cases I'm working on (no names, ever) and some observations about health in general. As ever, I look for any feedback I can get.
Cheers!
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