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CASE HISTORIES AND EXAMPLES OF TREATMENT WITH ACUPUNCTURE

This chapter describes in brief some of the common diseases in which acupuncture is effective and the response, which the patient should expect with treatment. Acupuncture is also useful in many chronic diseases, some of which are described below.

ALLERGIC RHINITIS.

Allergic Rhinitis is a common ailment where the patient complains of a recurrent running nose. The patient may have sneezing or a running nose for a few hours every morning, which can persist all day. It is often aggravated by alcohol, smoke perfumes and certain odours. The conventional western treatment of allergic rhinitis is unsatisfactory and many patients with this problem are forced to take antihistamines or use nose drops throughout their lives.

This condition responds well to treatment with acupuncture. The patient is treated daily for ten days and during his period most patients feel substantially better. The patient is then given a break for a week and the treatment repeated for another eight to ten sittings. This is given initially on alternate days and then twice a week till the end of the course. After the treatment most patients are relieved of their problem for at least a year. If any misalignment of the facial bones is present like a deviated nasal septum, cranio-sacral osteopathy may be able to correct this condition leading to a permanent cure. The use of an ionizer helps reduce the pollutants and dust in the air and so reduces the incidence of this problem.

COMMON COLD, SORE THROAT, LARYNGITIS & PHARYNGITIS

Acupuncture is useful in many diseases including those ailments for which there are no conventional cures like a common cold. If the patient begins the treatment when the cold is just starting, the results are excellent and the cold is aborted before it has had time to establish itself. However, if the cold is already well established, then treatment may be required for two to three days to cure the problem.

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Acupuncture is also useful in treating acute sore throats, laryngitis, or tonsillitis. In these conditions the patient is given a rather long session of treatment ranging from half to one hour. The patient feels much better by the end of the treatment but the full effect of the treatment is felt only twelve to twenty-four hours later. I have treated many patients who were advocates, lawyers, or actors, and were afflicted with a sore throat before a crucial appearance or performance. These patients came and took treatment and by the next morning their voice was completely normal.

TOOTHACHE

Toothache can also be relieved with acupunture. A couple of needles are inserted in the hand the face or the ear and twirled around for a couple of minutes. This dramatically eases the pain in the tooth. In fact the analgesia produced by acupuncture is so profound that a tooth may be extracted under the influence of acupuncture analgesia. Even major work on the teeth can be undertaken using acupuncture analgesia. The duration of analgesia created by acupuncture varies from patient to patient and can extend from two to forty hours after the treatment.

CERVICAL SPONDYLOSIS

One of the commonest problems for which people take treatment with acupuncture is Cervical Spondylosis, also called Osteoarthritis of the cervical spine. This may manifest as a stiff neck, an inability to completely turn the neck or as a pain in the shoulder or the arm, with tingling numbness, weakness and a loss of sensation in either of the arms. This pain is often mistaken for pain arising from the heart especially when the pain radiates down the left arm.

Acupuncture effectively relieves the pain and restores mobility to the neck within a few minutes. Very often patients enter the clinic wearing a cervical collar and throw it away after treatment because they are entirely free from pain.

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A complete course of treatment for cervical spondylitis lasts between ten to twenty sittings. The patient is also advised exercises to strengthen the paraspinal muscles and often judicious and skilled manipulation of the spine is required to correct the underlying problem. If the patient is adequately treated then a recurrence of the problem is rare. Problems in the neck are generally associated with problems in the lower back that should also be treated simultaneously.

BACKACHE

A person who has cervical spondylitis invariably develops a problem in the lower back five years later. This may manifest as a low backache, sciatica or rarely incontinence. It may cause referred pain in other parts of the body, which are supplied by the nerve arising from the affected area of the spine. There may be pain tingling or numbness in the arm, hands, fingers, legs or the chest. A problem in the thoracic vertebrae, which lie behind the chest, may cause a pain in the chest or abdomen, which is often misdiagnosed and mistreated as a problem arising from the stomach.

Problems in the lower back can lead to pain tingling or numbness in the leg. Most problems, which arise from the spine (backbone), respond well to acupuncture. The treatment takes between ten to forty sessions to entirely relieve the pain. Following this the patient may require spinal manipulation to correct the under lying problem in the spine.

In experienced hands, manipulation yields fantastic results. In a patient who has no pain, the manipulation of the spine is easy and painless. In a person with pain, the resultant muscle spasm makes manipulation a painful and uncomfortable process. It is impossible to align the spine in a person with pain and local muscular spasm, as the vertebrae in the affected area are held tightly together by the spasm and cannot be manipulated. The series of clicks, which occur when people go to a chiropractor or an osteopath, are caused by manipulation of the adjacent normal vertebrae. The readjustment of the spine, which follows such a manipulation, often gives the patient relief from pain. The eventual result is to the disadvantage of the patient because by trying to manipulate the affected part of the spine, the manipulator has in fact thrown a normal segment of the spine out of alignment.

When the spine is perfectly aligned, the patient should not have a recurrence of the problem. The process of aligning the spine is a slow process, because a spine, which has been out of alignment for many years, cannot be expected to return to its normal alignment in a few days.

A diagram of the Spine showing the different vertebrae and the problems that arise as a result of any of these being misaligned is shown on the next two pages. As explained above most of these problems can be resolved using a combination of acupuncture and manipulation.

DIAGRAM OF THE SPINE

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The ailments caused due to spinal misalignment of the vertebrae are shown on the facing page.

Areas

Effects

CERVICAL VERTEBRAE

NECK REGION

Blood supply to the head, pituitary gland, scalp, face, brain, inner and middle ear, sympathetic nervous system. Headaches, insomnia, high blood pressure, migrane, nervous breakdowns, amnesia, chronic tiredness, dizziness, myopia, blurring of vision.
Eyes, optic nerves, auditory nerves, sinuses, mastoid bones, tongue, forehead. Sinusitis, deafness, eye troubles, earache, fainting spells, certain cases of blindness, headches.
Cheeks, outer ear, face bones, teeth Neuralgia, neuritis, acne or pimples, eczema.
Nose, lips, mouth, eustachian tube Hay fever, catarrh, hearing loss, adenoids, dizziness, pain in shoulder.
Vocal cord, neck glands, pharynx Laryngitis, throat conditions, pain in wrist.
Neck muscles, shoulders, tonsils Stiff neck, tonsillitis, whooping cough, pain & loss of sensation in fingers.
Thyroid gland, elbows, Bursitis, colds, thyroid conditions, pain in shoulder.

THORACIC VERTEBRAE

MID BACK REGION

Arms from the elbows down, including hands, wrists and fingers, esophagus and trachea. Asthma, cough, difficult breathing, shortness of breath, pain in lower arms and hands
Heart including valves and coronary arteries Heart conditions and certain chest conditions.
Lungs, bronchial tubes, pleura, chest, breast, Elbows. Bronchitis, pleurisy, pneumonia, congestion
Gall bladder, common duct Gall bladder conditions, jaundice, shingles
Liver, solar plexus, blood Liver conditions, fevers, low blood pressure, anaemia, poor circulation, arthritis
Stomach Stomach troubles including nervous stomach indigestion heartburn, dyspepsia
Pancreas, duodenum Ulcers, gastritis
Spleen Lowered resistance
Adrenal and supra-renal glands Allergies, hives
Kidneys Kidney troubles, nephrtis, pyelitis
Kidneys, ureters Skins conditions such as acne, eczema or boils
Small intestines, lymph circulation Rheumatism, gas pains certain types of sterility

LUMBAR VERTEBRAE

LOW BACK REGION

Large intestines Constipation, colitis, dysentery, diarrhoea
Appendix, abdomen, upper leg, knees. Cramps, acidosis, varicose veins
Sex organs, uterus, bladder, calves. Bladder troubles, menstrual troubles, bed wetting, impotency, knee pains
Prostrate gland, lower back muscles, sciatic nerve hips. Sciatica, lumbago, difficult painful or too frequent urination, backaches
Lower legs, ankles, feet Swollen or weak ankles and arches, cold feet, weakness in the leg’s, leg cramps

SACRAL VERTEBRAE

PELVIC REGION

Hip bones, buttocks Sacro-iliac conditions, spinal curvatures
Rectum, anus Piles, pain at end of spine on sitting
Cocuyx Painful Intercourse, Poor vision, Loss of sensation in fact.

After the patient is free of pain, he is manipulated and told to return and see the therapist after two to four weeks. He is then examined and if he needs further manipulation, this is done and he is called again for further treatment after two to three weeks. This process continues until the patient's spine is perfectly aligned. The patient is called back for a check-up every three months until the therapist is satisfied that the spine is aligned and is likely to stay in place. The patient is also advised certain exercises which have been derived from Yogic asanas, to help strengthen the muscles which lie on either side of the spine and serve to hold the spine in place.

The spine can be thrown out of alignment by an accident, a fall or any accident causing a jerk to an unprepared spine. In this event, the patient is advised to return to his doctor as soon as possible for a check-up. If any problem has occurred in the alignment of the spine, this can be corrected before any symptoms appear.

ARTHRITIS

One of the commonest problems treated at acupuncture clinics is Arthritis. There are four or five different types of arthritis of which the acupuncturist normally sees only two types. Arthritis constitutes 20 to 40% of the patients seen by an acupuncturist. Of these roughly 75% have Osteoarthritis, and the balance have Rheumatoid Arthritis. Osteoarthritis normally affects large joints like the knees and hips. It may also occur in other joints especially those, which have been operated or injured. Rheumatoid Arthritis can affect any joint and normally affects multiple joints like the fingers, toes, elbows, ankles, knees and the spine.

OSTEOARTHRITIS

The treatment of Osteoarthritis is fairly short with most patients needing between ten to thirty sessions of treatment to be entirely free of pain. Depending on the severity of the arthritis, the patient can expect a pain free interval of two to fifteen years. Whenever the problem recurs the patient is advised to return for treatment as early as possible if the patient returns for treatment within the first few weeks of the recurrence of his pain. He may require as few as three to four sessions to be pain free again. The following is a typical example of a patient with Osteoarthritis. Ms Daniel, a large lady in her late sixties, came to see me with an eight-year-old complaint of pain and creaking in her knees when she walked. At first she had been able to keep moving with the help of painkillers but now even with the tablets she was unable to move without pain. Arthritis in the knees is due to wear and tear of the cartilage in the joint, which normally, follows an injury 15 to 2O years earlier. The injury causes the growth of new bone, which wears away the cartilage opposite the injured area. Gradually, over the years the cartilage is completely worn away and replaced by bone. At this stage, movement is very painful and restricted. The body secretes an excess of lubricating fluid in an effort to minimise the pain and to facilitate movement, leading to a swelling of the joint. This swelling is harmless and tells us that the body is trying to help itself. Ms Daniel wanted to know how acupuncture would repair the damaged knees. When a person has pain in a joint, the muscles around it contract in an effort to restrict movement; this pulls the joint surfaces closer to each other and increases the wear and tear. Acupuncture removes the pain and relaxes these muscles. The result is that the joint is able to move freely and vicious cycle is broken. Gradually nature takes over and the damaged cartilage often regenerates.

It is important in arthritis to keep the joint moving. Walking and simple knee bending exercise is all that are required to keep the knee mobile. Heat in the form of a hot water bag is helpful and as effective and safer than infrared or short wave diathermy, which you may receive in a physiotherapy department. A hot water bag is useful in cold or damp climates where arthritis often plays up.

Mrs Daniel received acupuncture treatment for about fifteen sessions and at the end of treatment was free of pain.

RHEUMATOID ARTHRITIS

Rheumatoid arthritis responds to treatment slower than osteoarthritis. This is an inflammatory process, which involves the joints as well as other parts of the body. The patient is treated every day until he has had ten sessions after which he has given a break for a week. He is then treated daily again for ten sittings, followed by a further break of a week. This process is continued for three to four courses of ten sessions each till the patient is entirely pain free.

The ESR (Erythrocyte Sedimentation Rate) of the patient is monitored regularly to assess the progress of the rheumatoid activity. With treatment, the ESR should start to fall and should continue to fall even after the treatment is over, until it reaches normal levels. The normal value of the ESR by the Westergreen Method in a male is up to 10mm fall in the first hour, while in ladies the accepted value is up to 20mm in the first hour. The patient is advised to have the ESR checked periodically to monitor any increase in Rheumatoid Activity.

The early deformities of Rheumatoid Arthritis can be reversed using Ultrasound. Ultrasound therapy followed by gentle manipulation can make joints that have become stiff, loose and free and can prevent the deformities from becoming worse.

After three to four courses of treatment the patient has a pain free interval of at least nine months. Whenever the pain, stiffness or swelling recurs. The patient is advised to return immediately for a course of treatment. The patient is then treated for one or two courses of ten sessions until the pain, stiffness and swelling subside. He can then expect a further pain free interval of eighteen to twenty four months before the pain returns again. When the pain recurs the patient is treated again, following which he should have a pain free interval of four to five years. In many palenty the decrease burns out and I now have patients who have not had a recurrance for fifteen.

BRONCHIAL ASTHMA

Asthma is a chronic disease in which the patient suffers from recurrent episodes of bronchial spasm, which reduces the movement of air into and out of the lungs. Bronchial Asthma is an immune disorder, which is characterised by an exaggerated and abnormal immune response to things normally present in the environment. These include pollen, pollutants, cigarette smoke, household dust, alcohol, various foods and spices. Acute attacks can also be precipitated by emotional, mental, or physical stress and by infections affecting the respiratory tract.

This disease causes a lot of suffering and does not respond well to conventional Western medicine, which gives a purely symptomatic treatment. With this treatment the patient requires progressively increasing doses of bronchodilator drugs which gradually lose their efficacy. Eventually patients are prescribed cortico-steriods with all their attendant hazards.

Duration of Treatment

Many patients take acupuncture or laser therapy for asthma to which it responds well. Acupuncture gradually restores the immune status to normal and the patient stops being allergic to common household substances. The total duration of treatment is about six months, which may be longer if the patient is taking corticosteroids. As a change is required in the body's immune status, it is a slow process. The patient is treated daily for a course of ten days and then given a break for a week. He is again given a course of treatment for a further period of ten days, followed by a break of a week. This process is continued till the patient feels better. Once he starts to feel improvement, the drugs are gradually tapered off while continuing the treatment, till the patient is off all drugs.

The disease is prone to periodic exacerbations, which are very distressing for the patient, his friends and relatives. When a patient gets an acute attack of asthma, the heavy laboured breathing causes relatives to panic. Some patients quickly despair and discontinue the treatment, forgetting that asthma is prone to undergo cyclical changes. There may be periods when the asthma is actually increased and there are periods when the asthma is relatively quiet. The cooperation of the patient is essential at this time, so that they follow the instructions of their physician rather than frantically assume that the treatment is not working and rush to take different types of bronchodilator drugs.

Results of Treatment

After the patient has stopped all the drugs he is treated on alternate days, then twice a week and finally once a week. This entire process takes about six months. At the end of six months the results are impressive. Virtually all patients have stopped taking all drugs. Sixty per cent of the patients can expect to be symptom free five years after the end of the treatment. Twenty-five to thirty per cent will require periodic follow up treatment every three months. Ten per cent of patients will not benefit substantially from the treatment even though they have been well throughout the treatment lasting for six months.

On cessation of the treatment, these 10% are likely to continue having attacks of asthma. However even these ten per cent of patients are able to manage their asthma with fewer drugs than they were taking before being treated with acupuncture. Many of these patients have food allergies which if identified and those foods are avoided, being permanent relief.

Precautions for Asthma patients

As bronchial asthma can be precipitated by various pollutants, it is wise to try and minimise their effects. An ionizer, which is an instrument, which generates negative ions, is a particularly effective method of cleansing the air, as the pollutants are precipitated out of the air in the form of particles.

Asthma can also be precipitated by infections like colds, sinusitis, sore throats, ear infections and bronchitis. It is a wise precaution for people who have been treated for asthma not to neglect these illnesses and to treat them promptly. This should prevent any recurrence of the problem.

HYPERTENSION

Hypertension or high blood pressure is a common ailment, which affects a large number of people. Modern medicine does not really understand why the blood pressure rises. In ninety percent of patients, no cause for the increased blood pressure can be found, so these people are described as having idiopathic hypertension or essential hypertension. Many of these patients are placed on antihypertensive drugs, which adequately control the blood pressure, but unfortunately, this treatment has to be continued life long. As these drugs all have side effects, many patients are unhappy at the idea of having to take a drug life-long so they look for other means of treatment.

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Acupuncture is an effective treatment for high blood pressure. It has been seen that in many patients with essential hypertension, there is an altered ratio of Alpha and Gamma endorphin in the brain. Each of these different types of endorphins has a different effect. Alpha endorphin increases the blood pressure while Gamma endorphin tends to bring it down. A person's blood pressure is regulated by the ratio between these two different types of endorphins. Acupuncture is able to alter and normalise the ratio between different types of endorphins.

This form of treatment is successful in reducing and maintaining the blood pressure within normal limits without medication in 60% of patients. The patients who respond will continue to maintain a normal blood pressure without any form of treatment. Each patient is examined evaluated and a decision is taken as to which acupuncture points should be used. The patient is treated for half an hour every day, with laser or acupuncture for five to seven days. The blood pressure is checked at each sitting both before and after treatment. It is seen that after each treatment the blood pressure falls.

The patient is given treatment for one or two cycles of five days separated by an interval of a week, till the blood pressure comes under control. At his stage, an attempt is made to taper off the drugs by continuing the treatment in cycles of five days. The drugs are normally tapered on the first day of a five-day cycle, so that the resultant rebound elevation in blood pressure due to stopping the drug can be adequately controlled with acupuncture. Several such courses are required to normalise a person's blood pressure after the person is off all drugs. Once the blood pressure is normal the treatment is continued for another one or two cycles.

Sixty percent of patients, who have been successfully treated with acupuncture for high blood pressure, can expect to maintain normal blood pressure for the rest of their lives.

MIGRAINE

Another common problem which, acupuncturist's treat is migraine. Migraine is a condition, which does not respond well to treatment with allopathy, or Western medicine, which does not understand why migraine occurs. It may be due to a spasm followed by dilatation of the arteries of the scalp and brain. Once a migraine has developed, ordinary pain killers are not effective in treating the pain.

The normal allopathic treatment is aimed at preventive migraine by the use of drugs like propranolol and ergot derivatives, which prevent migraine from occurring. Unfortunately these drugs have a lot of side effects. This condition responds well to acupuncture and treatment may be given either during the migraine attack itself in order to relieve the pain or between attacks when the patient is well. Quite often a person with a so-called migraine may have other associated problems like sinusitis or cervical spondylosis. If any of these are present are treated appropriately with acupuncture..

EYE PROBLEMS

The success rate of acupuncture in treating eye disorders is impressive and varies from condition to condition. In patients with cataract, especially those with early or immature cataracts, a complete clearing of the cataract may be expected in three to twenty sittings.

In people with advanced on mature cataracts, the results are poor. About seventy percent of patients with early cataracts respond well to treatment with acupuncture.

Myopia on short sight responds well to treatment with acupuncture. Myopia of up to –3.5 can be treated with excellent results with a fair number of patients being able to discard their glasses. Above –3.5, improvement occurs but these patients have to continue wearing spectacles of a lower power.

Contrary to what most people believe we do not insert the needles for eye problems into the eye but into the arms and legs.

Almost all eye problems respond well to treatment with acupuncture including some which cannot be treated by any other means of treatment. These include age related maccular degeneration, optic nerve atrophy, retinitis pigmentosa, detached retina conjunctivitis and many other conditions including some types of blindness, due to nerve damage.

 

ACUPRESSURE

The word "Acupressure" means to press with a needle. The science of acupressure developed, as it was seen that effects similar to that of acupuncture could be obtained by pressing acupuncture points. The term acupressure implies the application of pressure on an acupuncture point with a needle without actually piercing the skin.

THE PRINCIPLE BEHIND ACUPRESSURE

When we are hurt, we instinctively hold the affected part and massage or press it to ease the pain. This is because pain in that part of the body can be temporarily eased by pressure over that pain. A headache can often be relieved by pressure on the temples.

Over thousands of years, this principle was redefined into a fine art as it was seen that pressure at various parts of the body could alleviate problems elsewhere in the body. Gradually it was found that pressure with a sharp object appeared to be more effective than pressure applied with the fingers. This was the origin of the art of acupressure.

A form of acupressure and martial art called Kalaripayatt is practised extensively in south India especially in Kerala. This form of treatment spread from India to Indonesia and Japan around two thousand years ago and gave rise to Shiatsu and the various Japanese martial arts. The Japanese form of acupressure is called "Shiatsu" and is a highly developed form of treatment. The knowledge of pressure points is also used in the Japanese martial arts like karate and Judo.

HOW IS ACUPRESSURE APPLIED

Acupressure can be performed in many ways. The classical way of doing it is to use a blunt needle to apply pressure over an acupuncture point. However acupressure can also be carried out by pressing with your nail or any other blunt object. The pressure can be applied and released a number of times. The duration of pressure is dependent on how painful the point is. If it is very painful, the point is pressed every few minutes for a few seconds. This process is repeated till the patient finds that the point is no longer as painful and he can withstand greater pressure for a longer time.

If there is no pain at the acupuncture point, continuous pressure is applied for thirty to ninety seconds till the required result is obtained.

ADVANTAGES OF ACUPRESSURE

Acupressure is a useful means of treatment as it can be carried out without any special equipment. In an emergency the fingers or a ball point pen can be used to apply acupressure, which can dramatically ease the symptoms. A friend of mine fractured his ankle in a motor cycle accident and was in intense pain. I applied acupressure on his hand and ear and within a minute his pain had dramatically eased. We were able to take him to hospital and set his ankle without the need for general anaesthesia as advised by the orthopaedic surgeon. Acupressure was applied on his hand and ear and he was easily able to withstand the normally intense pain of the procedure.

I was once travelling in the hills by jeep and the lady next to me was feeling very car sick. I pressed her forearm above the wrist and within a few minutes she was no longer feeling nauseated. The best results from acupressure obtained when the therapist has an accurate knowledge of the acupressure points.

DlSADVANTAGES OF ACUPRESSURE

There are some disadvantages to acupressure. Only one acupuncture point can be treated at a time whereas in a patient we may need to treat several acupuncture points, especially so in patients with long standing problems.

The treatment is time consuming, as every point may need to be stimulated for five to ten minutes. The acupuncturist is thus obliged to stay with the patient throughout the treatment. In acupuncture the acupuncturist, is able to leave the patient alone for a few minutes whilst the needles take effect.

The acupuncturist needs to have very strong hands or he may find that he himself needs treatment for painful fingers. Acupressure is most effective when an acupuncture point lies over a bone and can be massaged against it. It is not so effective over soft areas like the abdomen.

REFLEXOLOGY

Reflexology is a form of acupressure, which is applied on the hands and feet. The entire human body with all its organs is represented in the hands and feet so pain in a specific area may indicate a disorder of the organ which is represented in that area. The tender points at massaged to tone up the organ with very good results.

SUMMARY

Acupressure is a useful means of therapy to be taught to lay people to enable them to help themselves with their problem. Asthmatic patients are often taught to insert their finger behind the breastbone at the base of the throat to relieve an acute attack of asthma. Pain due to any reason can often be eased by pressing between the thumb and the forefinger. Your acupuncturist can often advise you which acupressure points you need to treat, for your problems.

In general, acupressure is not as effective a form of treatment as acupuncture because the force, which is applied, is dissipated over a wider area. In acupuncture the needle enters a point which is less than two millimetres in diameter to create it's effect. Acupressure is more effective when it is carried out using a blunt needle which is at times considerably more painful than acupuncture carried out for the same ailment. With the advent of sophisticated and painless means of therapy like lasers and ultrasound the role of acupressure in therapy has diminished.