Acupuncture as an Essential Health Benefit – Public Input!

5/4/2007 11:02:59 PM

本文网址: http://www.epochtimes.com/gb/7/5/4/n1699998.htm

http://themidtowngazette.com/2011/10/acupuncture-in-new-york/

BY MENGWEI CHEN

“Trying to grow hair,” said Bill Cosby while receiving acupuncture on his sofa at home. Photo by Mengwei Chen

Lying comfortably on the sofa in his dimly lit house, the comedian Bill Cosby seemed pretty relaxed at 7:45 a.m. on Oct. 25, his eyes half closed and his smile charming, as usual, even though five 3-inch-long needles were inserted into his head, eight 4-inch-long ones were in his round belly, and 10 3.5-inch-long ones protruded from his legs and feet.

His favorite part of acupuncture treatment? “Moxibustion,” Cosby said in his serious joking mode, referring to the mugwort herb Dr. Ming Jin sometimes burns on his skin to smooth his flow of blood and qi. “I drink ‘em all.”

For Cosby, 74, this is his 20th year taking acupuncture. For acupuncture, this year marks the 40th anniversary since a New York Times correspondent introduced Americans to its benefits in an article titled ”Now, Let Me Tell You About My Appendectomy in Peking.” Four decades later, however, many U.S. insurers still refuse to cover the procedure, and sometimes even the ones who do will try to avoid paying the bill, acupuncturists say.

“It harms the benefits of both patients and acupuncturists,” said Dr. Xiaoming Tian, director of the Academy of Acupuncture and Chinese Medicine, speaking earlier this week at a 40th anniversary celebration in Flushing. “Three point seven million Americans have taken acupuncture in 2007. Eleven percent of them were children. That ratio is almost higher than China. Yet most of them are paying cash.”

Part of the problem is that long-standing conflicts between the two biggest Chinese acupuncture associations — the United Alliance of New York State Licensed Acupuncturists and the American Traditional Chinese Medicine Society — have slowed the legislative process, said Dr. Tian, the first clinical consultant on acupuncture at the National Institutes of Health and a former member of the White House Commission on Complementary and Alternative Medicine Policy.

“Why can’t Chinese acupuncturists stop wasting time on fighting each other and get insurance policy done?” Dr. Tian asked.

The answer is complicated. The two groups have failed to merge, because their philosophies are different and they disagree about whether an older generation of traditionally trained  acupuncturists is as qualified as younger, licensed practitioners trained in the United tTates.

On one side of the question is Dr. Ming Jin, from Shanghai, the former president of the united alliance, a 300-member union consisting mainly of senior acupuncturists who barely speak English. She owns Ming Qi, one of the busiest acupuncture clinics in Manhattan, located at 161 Madison Ave., near the Empire State Building. Her clinic only accepts cash. Bill Cosby is one of her many celebrity patients.

“I believe the first rule is to make money,” said Dr. Jin. “I told all my members to learn how to make money in America. That’s the foundation of anything above. Chinese acupuncturists should have our own economic entity, a company, a consortium.”

Her mentor, Dr. Jingyuan Ding, was the politically influential leader of a campaign that helped establish a 1975 state law, which legalized acupuncture and regulated the licensing process in New York, grandfathering in current practitioners. Dr. Ding had strong political ties to former Lt. Gov. Mary Anne Krupsak, State Judge Edwin Margolis and State Sen. James Donovan. When Dr. Ding died of a sudden heart attack at a restaurant table, Dr. Jin was the first one called there.

“When I saw him lying in the mortuary the last time, I knew, his things were not done. I must carry his mission on. I must do all I can as a human,” she said.

Dr. Jin said her biggest dream is to merge with the medicine society to form a coalition of Chinese acupuncturists, creating a strong, unified voice when appealing to governments. “We tried to cooperate in 2006, but it was a failure,” recalled Dr. Jin. “We have many seniors who made great contributions before these young acupuncturists, but they did not know how to respect them or give them proper positions.”

On the other side of the dispute is Ling Zheng, from Fuzhou, China, a licensed acupuncturist who is the secretary of the medicine society, which has 700 members,  most of whom are younger and trained in modern oriental medicine schools with western medicine knowledge. He has worked at his small office at 14 E 34th St. since 1996.

He is famous for his expertise in arguing with, and sometimes suing, all sorts of insurance companies to get paid. (A typical acupuncture may cost from $100 to $200.) Zheng said that two-thirds of his patients did not need to pay cash, a rare situation. He shares all of his tactics for dealing with insurance companies with members of the medicine society, for free. But he does not do the same for members of the united alliance.

“Those group of people never accept new things. All they want is to make easy money in Chinatown,” said Zheng. “Even if I give them what I have, they won’t get the money from insurance companies, because they don’t speak English.”

Talking about collaborating with the other organization, Zheng said, “We are different people. I personally think money is dirty. I want our organization to stay academic and professional. I admit that the united alliance is better than us in business, but we have different ways.”

“In our organization, your position depends on what you are doing, not what you did decades ago.” said Zheng. “But they want to send every one of their old folks above our head to give orders. Ridiculous. If the two organizations are to merge, it is after I step down.”

For centuries, Eastern cultures have known the value of acupuncture. The earliest recorded use of acupuncture in history occurred in China over 2,200 years ago.

Modern scientific research has not been able to fully document how acupuncture works. According to U.S. National Center for Complementary and Alternative Medicine reports, for which Dr. Tian Xiaoming and his team interviewed over 1,700 doctors and patients, acupuncture is effective for at least relieving pain and nausea. The way it works: Acupuncturists insert their power through needles into certain points to remove blockage of the flow of Qi, the inner vital energy, and to reach a balance of contradictory forces of Yin and Yang.

Dr. Roger Tsao, 68, from Taiwan, who never went to a formal acupuncture school but has acupuncture licenses from the states of California, Florida, New Jersey and New York, has been practicing acupuncture in New York since 1969. When he started the business, many acupuncturists dared only to treat horses and dogs.

Dr. Tsao, who is bilingual, once participated or collaborated with almost all acupuncture. He was one of the 11 members of the New York State Board for Acupuncture from 1999 to 2004. But now he has quit everything.

“I’m tired of seeing Chinese people fighting each other for positions and titles,” said Dr. Tsao. “I’m too old to bear with that. They only want to kick you off and be the boss. But they never ask if they are good enough to be the leader.

“We definitely need a whole union, like those chiropractic physicians,” Dr. Tsao said, “but I’m not sure if I can see this day.”

Currently, Dr. Tsao works as a part-time professor at the Pacific College of Oriental Medicine, which is the largest school of Traditional Chinese Medicine in the nation. Over 70 percent of students are American, paying  tuition of  about $250,000  in a degree  granting program that takes three and a half years to complete.

In 1972, President Richard Nixon visited China and officially opened the gate for acupuncture.

Nearly 40 years later, Bill Cosby is enjoying regular 45-minute sessions at home. “Beneath that picture you just took of my head,” demanded Cosby, “please write: ‘Trying to grow hair.’”

Dr.Arthur Fan has been rated as one of  ”top acupuncturists” in Washington DC and northern Virginia area in the Website: www.RateMDs.com.

Here we have a case record in video, I hope patients with Guillain-Barre Syndrome don’t get frustrated, use acupuncture or/and Chinese herbal medicine as early as possible, in most of cases, very good.http://www.youtube.com/watch?v=6Ngu5WrPDcE&feature=youtu.be

http://ahref=

My reply is: “Yes. In most of the cases, acupuncture does  help the patients to stop mild vaginal bleeding during their early stage of the pregnancy.”

We had at least 8 successful cases since 2007.

Stopping the vaginal bleeding means stabilizing the condition which may induce the miscarriage.

One patient.Ms.T.M. came today, she had brown color-like bleeding in her vaginal discharge 4 days during her pregnancy week 6.  After one time acupuncture, the brown color disappeared.

from http://chinesemedicinetopics.wordpress.com/2010/05/11/%E2%80%9Copening-through%E2%80%9D-the-menstruation-tong-jing-%E9%80%9A%E7%BB%8F/

May 11, 2010 by sharon weizenbaum

I’ve been away in Taiwan for the last month and have unfortunately neglected this blog while I was away!  I hope I didn’t lose your attention!  If you are interested in our travels in Taiwan you can click here for the little blog of our trip.   Well I’m back and have some interesting material to post that I hope you’ll enjoy!  I am going to do a series now, relying heavily on the work of Dr. Xia Guisheng.  I’ll start here with a brief introduction to Dr. Xia and and follow this with a discussion of learning some of the subtleties in treatment and the term that I am translating as “opening through”.  I’ll follow this with some entries that include the writings of Dr. Xia together with some of my own clinical experience utilizing his insights.

Dr. Xia is the director of the Gynecology Department at the Affiliated Hospital in Nanjing and professor of Gynecology at the Nanjing University of Tradition Chinese Medicine.  Bringing  over 50 years of experience and insight to his writings, he is not only a highly effective practitioner, he is also a clear teacher/writer.  His material is written in a way that guides the student/practitioner through the necessary steps to gain understanding.

 

He has pioneered the articulation of the theories that direct us to work with the ebb and flow or Yin and Yang in relation to the menstrual cycle.  He applies this understanding to all areas of gynecology in great detail.  It is no surprise, after reading his books, to discover that he has become know as a manifestation of Guan Yin, the Chinese goddess who come to the aide of women and children.  Though he is perhaps best known in the West for his work with modifying formulas according the the timing of the menstrual cycle, Dr. Xia pays such close attention to the details of patho-physiology in combination with the function of formulas and the individual herbs within them that his books are really a treasure trove of useful gems.  In this particular series, I will be paying attention to his work with blood stasis and the idea of “opening through” in relation to women’s physiology, patho-physiology and menstruation.  These ideas have many implications in the treatment of women including but going beyond the treatment of dysmenorrhea and infertility.

Most entry level Chinese herbalists have a very limited idea of gynecological blood stasis, it’s diagnosis and treatment.  This becomes very apparent as the practitioner works with women in the clinic and finds that so much of what was learned in school simply doesn’t work or works in a way that is far from ideal.  Poor clinical results can be frustrating but they can also push us to learn more and can help our diagnosis and treatments become more nuanced. For me, less than excellent results have pushed me to research many topics, including the topic of “opening through” in relation to gynecology.  This topic also brings up the concept of a more nuanced use of individual herbs.  In relation to blood stasis – many of my own students don’t come in with much more of an understanding of blood stasis herbs other than that they all move the blood and that they should therefore not be used when there is heavy bleeding or during pregnancy.  And yet, through experience we learn that sometimes we must strongly move the blood in order to stop heavy bleeding and that sometimes moving the blood can help prevent a miscarriage.  We also learn that all blood vitalizing herbs are not equal to each other nor the same as each other.  They range from strong to weak and from cold to hot.  Some are especially good at stopping pain, others are especially good improving the quality of the blood itself.  Here is a bit of a preliminary list just some of the various functions of some individual blood vitalizing herbs:

Stopping pain

Softening hardness

Cracking stasis

Warming the blood

Regulating the Qi within the blood

Stopping bleeding

Harmonizing the blood

Nourishing the blood

Supplement the Kidneys

Descend the Heart blood to the uterus

Cool the blood

Relieve constipation

Open up the chest and breast area

And finally blood vitalizing herbs that function to “open through” the menstruation…..

I first noticed that there was something going on with this idea of “opening through” when I was working beside my teacher Dr. Sheng Yufeng, in Hang Zhou, PRC.  I was constantly trying to figure out why she would use particular herbs in particular situations.  I noticed that there were times she would give a formula for blood stasis and include herbs like Huai Niu Xi or Chuan Niu Xi along with herbs such as Su Mu, Chong Wei Zi and Shan Zha.  I wanted to know when and why she used these herbs.  It was not until I found the writings of Dr. Xia Guicheng that these ideas were fulling articulated for me.  Since studying these writings, the diagnosis and appropriate treatment methods for of some patients in my clinic has become clearer and the treatment results improved.

So, what is this “opening through”?  I am translating the character 通, tong1. as “opening through”.  The Eastland Press glossary translates this as “unblocks, promotes, pervades”.  Wiseman and Ye’s Practical Dictionary of Chinese Medicine, Second Edition translates this term variously as “free, open, restore flow, unstop and connecting.  Thinking of this as “opening through” just what gets opened through?  This term is used when the Luo vessels, the channels, the Qi, the lactation, the bowels, the nasal passages, the blood vessels, the urination, the Ren vessel and finally, the menstruation are blocked. What I want to point out in relation to all of these functions is that what is being “freed” or “opened” or “connected” all relates to structures in the body that are tubular.  This is why the idea of “opening through” is useful.  It gives us the image, not only of blockage, but of a tube that is blocked up and needs to be opened.  Though the term “unblocking” may suffice, it does not convey the image of a tube that should be open end to end the way that “opening through” does.  I have to admit “opening through” is a rather bulky term though, but at least for now, I’d like to use it to effectively illustrate the physiology, patho-physiology, treatment principles and function of herbs.

A bit more about the character tong1 通. It is made up of two parts. The first is this: 甬 yong3 which carries the meaning of path or corridor.  The second is 辶 chou4, which carries the meaning of walking or going.  So altogether we have the meaning of movement through a corridor or path.   When we take the 甬 yong3 corridor or path part of the character and combine it with the disease radical getting 痛 tong4, meaning pain.  In other words, when the corridor is pathologically effected, there is pain.  The characters 通 and 痛 are the one’s that are in the famous saying 通则不痛，不通则痛,  or when there is opening through there is no pain and when there is no opening through there is pain.

So what is this tube that is related to “opening through” the menstruation?  This tube is related both to the Ren Vessel and to the Bao Tai, which connects the upper body, especially the Heart and chest, to the uterus.  This tube can get blocked up and when it does, it needs to get opened through from end to end.  Various symptoms can arise when this tube gets blocked up including amenorrhea, scanty menstruation, lack of free flow of menstruation, painful menstruation, heavy menstruation and infertility.  Upper Jiao symptoms can involve the breasts, the head, the emotions or even cause bleeding in the upper warmer as the menstrual blood fails to descend.  The blockage can effect the middle Jiao as well.  Recently I successfully treated a woman with Achalasia, which involved difficulty swallowing and esophageal spasming that was worse premenstrually, integrating the method of opening through the menstruation.  In general, when the menstruation is not open through, a failure of the downward movement of the Qi mechanism can lead to a whole variety of upward rebelling symptomatology in addition to the lower warmer issues.

Before moving on to the entries that include the Dr. Xia’s writings on this topic, I want to include a bit about how he organizes his discussions in his book, Gynecology Formluas and Herbs from Clinical Experience and Study in Fifteen Chapters. In this text, Dr. Xia has a whole chapter devoted to the idea of “opening through”.  He divides this chapter into 8 parts, each part being represented by one of his “opening through” experiential formulas.  He begins with a basic formula Jia Yu Tong Yu Jian (modified Opening Through Stasis decoction) which is based on Zhang Jingyue’s formula Tong Yu Jian (Opening Through Stasis decoction). He uses this formula as a jumping off place for the deeper, more detailed discussion of the topic.  The formulas that follow morph off of the original idea in the variety of ways that Dr. Xia sees most often in his clinical work.  By carefully going through each chapter, the practitioner learns, not only about these particular formulas but so much more.  We learn how to modify a formula to suit a variety of clinical realities but more importantly, we learn about women’s physiology and patho-physiology in great depth.  Finally, we learn about the individual herbs and their nuanced and careful use.  It is like looking at an issue through a variety of lenses until we feel we have quite a complete understanding.  I’ve not previously seen texts organized in this manner and have found it to be an excellent way to transmit his valuable information.

So, stay tuned!  Dr. Xia’s writings will soon be posted here!

From: http://www.wfas.org.cn/en/show.asp?liststate=0&action=&men=3&Position=&id=1616&pageshow=1#

World Federation of Acupuncture-Moxibustion Societies.

(Author: Liu Jin；   source：information center, Published in 2009)

    据文献载中医药、针灸早在17世纪便由中国传入欧洲，再由欧洲传入美国。最早在美国出版英文版本针灸专书的是一位名叫F．Bache 的美国医师翻译由S．Morant所著的法文针灸 书，该书于1825年在费城出版（ S． Morant： Memair on Acupuncturation）。次年即 1826年 F．Bache。进一步又在北美内科与外科杂志发表 他本人用针灸所治疗的病例报告（F．Bache： North American Medical and Surgical jourrnal l：311-321，1826）。此后便陆续有一些有关针 灸论文在美国发表。经过一百余年后，1942年 E．A．Brav与H．Sigmond曾在美国军医杂志上 报告针灸的疗效，特别强调针刺止痛的疗效 （E.A.Brav：Military Surgeon,9）：545－549， 1942），可见在当时已将针灸疗法逐渐介绍到军医中采用。

    华人先侨随着美国自1848年开始的淘金热、铁路热及采矿热之后而大量涌入美国。不久之后，在旧金山及纽约等地随着华埠的出现便开始有一些老中医及针灸医师悬壶济世治病救人，真正的中医药/针灸医术亦随之在美国出现。但在美国掀起“中医针灸热”的要归功于著名报人赖斯顿（James Reston）。赖氏曾任纽约时报副总编，著作颇丰，蜚声国际。1971年赖氏随尼克松总统访问北京后（Arthur Fan Notes: it is before President Nixon’s visit)，因患急性阑尾炎而入住协和医院进行手术。手术时及手术后曾用 针麻止痛，疗效甚佳。他于7月康复出院后详细着文介绍了亲身经用针刺止痛的经历及中国中医药的发展和中西医结合的情况，加上电视的播放，霎时间中国针灸针麻的奇迹便展现于美国的千家万户，针灸诊所的患者络绎不绝，对中医针灸医师之需要亦随之大增，不久针灸学校应运而生，歧黄医术随之渐盛于美国。

    由于受到美国“中医针灸热”的影响，美国国立卫生研究院（NIH）于1972年7月成立了“针刺疗法特别委员会”，由麻醉学者、神经病学 者及生理学者等人组成。其主要任务是：复习中国有关文献；组织调查研究有关针灸情况以 及举行针灸学术研讨会等。该委员会于1973 年3月在马里兰州比塞大召开了第一次学术会 议。会上有40余项有关针灸方面的初步研究 成果进行了交流。该会主席J．Bonica教授（华盛顿大学医学院麻醉科主任）在总结发言中指出：“现有资料证明针刺疗法是有效的，这对医 学是重要的。针刺作为某些外科手术中的一种 麻醉方法和一些急性和慢性疼痛的治疗手段是 有希望的。但要在美国广泛开展临床针刺治疗 之前，必须进行妥善精密的设计和严加管理的 科学研究（Proceeding NIH Acupuncture Res each Conference，VI，1973）。

      同一时期美国出版了两份国际有名的中医 针灸杂志。一为美洲中国医学杂志（The Americanl ournal of Chinese Medicine ），于 1973年1月出版，为季刊。另一为美国针灸杂 志（Americann Journal of Acupuncture）， 于1973 年3月发行，办为季刊。

    这一时期有些学者还 相继在美国各地成立了有关中医针灸的学术性团体，如美国中国医学会、美国全国针灸研究学会等，都对推动中医药/针灸事业在美国的发展 起了积极的推动作用。

网上有人写文章，谈到美国第一个州通过针灸立法的是加利福尼亚，实际上有误。第一个通过针灸立法的应该是内华达，而马里兰和俄勒冈是同一年（1973年）通过立法的。华盛顿DC 是1989年，维吉尼亚则是1993年。

以下资料来自于美国中医师公会，是权威资料。

State Legislative Initiatives: The first practice act legislation was enacted in 1973 in Nevada Maryland and Oregon. Today, 44 States (PDF), plus the District of Columbia have enacted practice acts.

1973-Maryland, Nevada & Oregon
1974-Hawaii, Montana, South Carolina
1975-Louisiana, New York(I think), and California
1978-Rhode Island
1981-Florida & New Mexico
1983-New Jersey & Utah
1985-Vermont, Washington
1986-Massachusetts, Pennsylvania
1987-Maine
1989-Colorado, District of Columbia, Wisconsin
1990-Alaska
1991-New York(I think this should be the year for re-publishing the sate law)
1993-Iowa, North Carolina, Texas, Virginia
1995-Connecticut, Minnesota
1996-West Virginia
1997-Arkansas, Illinois, New Hampshire
1998-Arizona, Missouri
1999-Idaho, Indiana
2000-Georgia, Ohio, Tennessee
2001-Nebraska
2005-South Carolina
2006-Kentucky, Michigan

2009 -Alabama

1. Xia Guicheng Practical Chinese Gynecology (Paperback) by 2009 Chinese Medicine Press; 1 edition (October 1 (Paperback - Oct 1, 2009);

2. Gynecology of Traditional Chinese Medicine by Tan Yong (Paperback - 1991)

3. Chinese Gynecology chart solution (paperback) by TAN YONG (Paperback - Sep 1, 2008)

4. Gynecology of Traditional Chinese Medicine (Library of Traditional Chinese Medicine: Newly Compiled Practical … (English and Mandarin Chinese Edition) by Tan Yong(Paperback - 2002)

5. Treatment of Infertility with Chinese Medicine by Jane Lyttleton (Hardcover - May 10, 2004)

6. Obstetrics and Gynecology in Chinese Medicine by Giovanni Maciocia CAc(Nanjing)(Hardcover - May 20, 2011)

7. Xia Guicheng ( hundreds of years of clinical family medicine series) [Paperback]TAN YONG 

Xia Gui-Cheng (1932 -) is a professor of gynaecology at Nanjing TCM College, and has been involved in teaching, research and clinical treatment for over 30 …

Xia Guicheng « Topics in Chinese Medicine

This week, a patient saw me for her low back pain. She told me she saw me because she feels comfortable with me and my acupuncture. She said she got a pair of twin boys after my one acupuncture treatment 5 years ago–this is really a good news, but I spend 5 years to get it!

There have been over 55 pregnancy success cases after our treatments since January, 2007.  Actually, there may be some more didn’t report to me. I hope I could get the news in time.

France Guevin, BS, Marc Steben, MD, Yves Lepage, PhD, Bernard Lambert, MD

Original article from http://www.medicalacupuncture.org/aama_marf/journal/vol17_1/article3.html

ABSTRACT
Background Vulvodynia, characterized by burning sensation, pain, and pruritus, is often treated with antidepressants. Recent studies indicate that acupuncture may be an effective modality.
Objective To evaluate the short-term effect of acupuncture on vulvodynia.
Design, Setting, and Patients A convenience sample of 13 patients in a private clinic setting.
Intervention Acupuncture at 3 main points for all patients: BL 22, SP 6, and LV 5, alternatively on the left and right meridians, in 4 weekly
treatments.
Main Outcome Measure Pain measured on a 10-point visual analog scale (VAS) before and at the end of treatment, and 3 months later (at 4 months).
Results Significant differences (at P<.001) were observed between pretreatment, and 1 and 4 months later, from a VAS mean of 8.69 to 4.38 and 2.31, respectively.
Conclusions Acupuncture appears to be a possible alternative to antidepressant treatment for vulvodynia. A longer surveillance period is
needed to verify our results.
KEY WORDS
Vulvodynia, Acupuncture, Vulvar Dysesthesia, Vulvar Pain, Visual Analog Scale (VAS)

INTRODUCTION
The prevalence of vulvodynia, or generalized vulvar dysesthesia, is largely unknown in the general population.¹ It was described by Tovell and Young in 1978² as an undetermined disorder in 26 patients (2.6%) in a series of 877 consecutive cases. The diagnosis was founded on an eliminatory basis for skin lesions. Patients were distressed by a burning sensation, pain, and pruritus, and the term “pudendagra” was used. The concept of vulvodynia or chronic vulvar discomfort was accepted in 1984.³ McKay4 differentiated pruritic symptoms, as associated with skin changes, thus confirming vulvodynia as an exclusion syndrome associated to a disorder of unmyelinated C fibers. Tricyclic antidepressants amitriptyline and desipramine are typically first-line therapies5 but recently, new avenues have been evoked in 2 pilot studies on acupuncture for the simplicity of use and rapid clinical response.^6,7

Danielsson et al,⁶ using a visual analog scale (VAS), noted significant changes (P=.01) for negative quality of life at 3 months following treatment: from a score of 7.2 to 3.2 in a series of 14 women. Pain at coitus was included in the sample of vulvar vestibulitis. Powell and Wojnarowska7 reported in 1999 a clinical response in 12 patients: 2 of the cases were stratified as cured, 3 cases with partial improvement, and 4 slightly improved.

In order to verify the possible action of acupuncture on vulvodynia, we reviewed 13 cases of generalized vulvar dysesthesia, without any coital pain or sexual interference.

METHODS
Thirteen patients with general vulvar dysesthesia filled out the Stanford pain visual questionnaire (VAS, 1-10) in an office setting with us.⁸ Verbal consent was obtained from all patients. No double-blind intervention or controls were used; this pilot study was strictly an evaluation of acupuncture effectiveness on vulvodynia patients. Patients were seen by their physician before and after acupuncture; they were informed about the technique and mechanisms on all spheres of their body, nervous system, Qi/xue, body, and mind. Our inquiry included patient age, duration of disease, and pain score before acupuncture, at 1 month, at the end of 4 weekly treatments, and at 4 months, or 3 months after the end of the treatment. All patients were screened by us and screening included a negative Q-Tip test, wet smears, vaginal cultures, and a negative clinical vulvar examination. An acupuncturist performed all the treatments. Dermatological lesions such as eczema, psoriasis, lichen simplex sclerosis and atrophicus, and planus were excluded. Cyclic yeast vaginitis, human papillomavirus, vulvar intraepithelial neoplasia, and localized dysesthesia (vestibulodynia) were also excluded. Patients did not receive antidepressive or antiepileptic medication at the acupuncture treatment or for 4 months thereafter.

Acupuncture is defined as an insertion of a needle on precise points of the body.⁹ The rationale is based on Traditional Chinese Medicine (TCM), covering Yin-Yang, Five Elements, Baguang, Meridians theories, and reflexology. According to the age of the patient and the duration of the problem, we referred to Liver (Shu Jueyin) and Bladder (Shu Taiyang) meridians (young persons, few months to a year of discomfort). Also, the Chong and Tae Mo (Curious Meridians) were considered. If symptoms were present for longer than a year, the diagnosis of Liver and Kidney Yin deficiency was considered, with apparent Fire or false Fire. In reference to the nervous system, neuralgia appeared stronger at the T2-T5 levels and lighter on L1-L5, including sacral holes painful pressure points. Literature sources are the confluence of French, Chinese, and American studies.⁹
Stainless steel needles from 2-6 cm and 0.25 mm diameter (#32), and 6 cm and 0.25 mm diameter (#32) were used (Suzhou Shenlong Medical Apparatus Co Ltd, China). They were individually packed in an aluminum and plastic plate of thin needles, then sterilized and discarded after a single use.

Needles were placed according to the chosen locations and the person’s size, at a depth of 2-10 mm, perpendicularly or longitudinally, with different angles. Needles remained in place for 20-30 minutes in a comfortable position. We use needles without any manual or electric stimulation. Treatment was repeated weekly for 4 sessions. (Patients may indicate a pinch when skin is pierced. A feeling of numbness may be experienced near the site of puncture but it disappears with the removal of the needle, with some variations to the patient’s pain threshold.) Three main points were used for all patients: BL 22, SP 6, and LV 5, alternatively on the left and right meridians (Figure 1). No Qi response or T-witch response was used . Other interventions were: moxibustion below the navel segment level, according to the season, age, and general condition of the patient, and recommendation to avoid cold at all levels of food, clothing, and space. This study was undertaken in a private clinic setting.

A single-factor analysis of variance with repeated measures followed by a contrast analysis using paired t test with Bonferroni correction was used to study the pain level before the treatment, after 1 month, and after 4 months. The association between the ages of the patients, the duration of pain, and the pain level was studied with Pearson correlation.

RESULTS
Patients’ mean (SD) age was 47.5 (15.3) years (range, 23-70 years) (Table 1). Mean symptom duration was 38.2 (18.6) months in 10 completed questionnaires. Mean pain score levels varied from 8.69 (1.75) in the pretreatment period to 4.38 (2.93) at 1 month to 2.31(2.66) at 4 months. These mean levels were significantly different (F=37.49, P<.001). Significant mean differences were observed between pretreatment and at 1 month (P<.001), and pretreatment and the end of the survey at 4 months (P<.001), and at 1 and 4 months (P=.02). One patient did not achieve any improvement, and another had a partial response (pain score reduced from 9 to 5). There were no treatment complications.

There wasn’t any significant linear relationship observed between age and duration (r=0.108, P=.77), age and pain levels at pretreatment (r=–0.230, P=.45), age and pain levels at 1 month (r=–0.327, P=.28) age and pain levels at 4 months (r=0.147, P=.63), duration and pain levels at pretreatment (r=0.195, P=.59), duration and pain levels at 1 month (r=–0.301, P=.40), and duration and pain levels at 4 months (r=-0.450, P=.19). The difference between the pain levels at 4 months and pretreatment was also not linearly related to age (r=0.259, P=.39) and duration (r=–0.502, P=.14).

Figure 1. BL 22 is located in the lumbar region and SP 6 and LV are on the antero-internal and mid-lower side of the leg

DISCUSSION
We are unaware of any controlled trials of acupuncture treatment for vulvodynia.¹⁰ A controlled trial comparing acupuncture with amitriptyline would be challenging, especially with medium and long-term follow-up. Neuropathic pain mechanisms in vulvodynia remain unclear.¹¹Recently, quantitative sensory testing showed increased vulvar pain presence and peripheral body regions¹² with the evocation of a possible central control mechanism. Reed et al¹³emphasized minimal differences between general vulvar dysesthesia and vestibulodynia, with no significant differences between both groups. They could be the variant of the same pathophysiological mechanism.

Sexual activities appeared similar between vulvodynic patients and controls,¹⁴ although frequency of intercourse or orgasm was less frequent in the affected group. Our study could be extended to vestibulodynia without the aid of physiotherapy or sexual therapy. A longer period of evaluation of up to 12 months is deemed optimal with inclusion of amitriptyline as control. However, our study raises hopes in the short-term management of a challenging and often undetected syndrome.

CONCLUSIONS
Acupuncture may be a possible alternative to antidepressant treatment for vulvodynia. A longer surveillance period is needed to verify our results.

ACKNOWLEDGEMENT
Many thanks to Bruno St-Pierre for Figure 1.

REFERENCES

1. Harlow BL, Wisc LA, Stewart EG. Prevalence and predictors of chronic lower genital tract discomfort. Am J Obstet Gynecol. 2001;185:545-550.
2. Tovell HMM, Young AW. Classification of vulvar diseases. Clin Obstet Gynecol. 1978;21:955-961
3. Burning vulva syndrome: report of the ISSVD Task Force. J Reprod Med. 1984;29:457.
4. McKay M. Vulvodynia versus pruritus vulvae. Clin Obstet Gynecol. 1985; 28:123-133.
5. McKay M. Dysesthetic (“Essential”) vulvodynia treatment with amitriptyline. J Reprod Med. 1993;38:9-13.
6. Danielsson I, Sjöberg I, Östman C. Acupuncture for the treatment of vulvar vestibulitis: a pilot study. Acta Obstet Gynecol Scand. 2001;80:437-441.
7. Powell J, Wojnarowska F. Acupuncture for vulvodynia. J R Soc Med. 1999; 92:579-581.
8. Stanford Patient Education Research Center Web site. URL: http://patienteducation.stanford.edu/research/painseverity.html. Accessibility verified June 25, 2005.
9. Guevin F, Bossy J, Yasui H. Nosologie traditionnelle chinoise et acupuncture. Paris, France: Masson; 1990.
10. White AR. A review of controlled trials of acupuncture for women’s reproductive health care. J Fam Plann Reprod Health Care. 2003;29(4):233-236.
11. Wesselmann U, Brunett AL, Heinberg LJ. The urogenital and rectal pain syndromes. Pain. 1997;73(3):269-294.
12. Gisecke J, Reed BD, Haefner HK, Giesecke T, Clauw, DJ, Gracely RH. Quantitative sensory testing in vulvodynia patients and increased peripheral pressure pain sensitivity. Obstet Gynecol. 2004;104(1):126-133.
13. Reed B, Gorenflo DW, Haefner HK. Generalized vulvar dysesthesia vs. vestibulodynia: are they distinct diagnoses? J Reprod Med. 2003;48(11):858-864.
14. Reed B, Advincula AP, Fonde KR, Gorenflo DW, Haefner HK. Sexual activities and attitudes of women with vulvar dysesthesia. J Obstet Gynecol. 2003;102(2):325-331.

AUTHORS’ INFORMATION
Ms France Guevin is an Acupuncturist in Montreal.
France Guevin, BS, d’Ac, MOAQ
415 Blvd Saint-Joseph East
Montreal QC H2J 1J6
Canada
E-mail: f.guevin@bellnet.ca

Dr Marc Steben is a Physician at the Vulvar Diseases Clinic at the Notre Dame Hospital Chum Montreal.
Marc Steben, MD
Vulvar diseases clinic, Hôspital Notre-Dame CHUM Montreal
1560 Sherbrooke E.
Montreal QC H2L 4M1
Canada
Fax: 514-528-2452 • E-mail: marc.steben@sympatico.ca

Yves Lepage, PhD, is a Professor of Mathematics at the University of Montreal.
Yves Lepage, PhD
Department of Mathematics and Statistics
C.P. 6128, Succursale Centreville University of Montreal
Montreal QC H3C 3J7
Canada
Fax: 514-343-5700 • E-mail: yves.lepage@umontreal.ca

Dr Bernard Lambert is an Obstetrician-Gynecologist, and Associate Professor of Obstetrics and Gynecology at the University of Montreal.
Bernard Lambert, MD, FRCSC, FACOG*
Dept of Gynecology, Hôtel-Dieu CHUM, University of Montreal
3840 St-Urbain
Montreal QC H2W 1T8
Canada
Phone: 514-890-8000, #12685 • Fax: 514-412-7213
E-mail: bernardlambert@vif.com

Ms. D.  a middle age Caucasus woman came to see me because she has been frustrated with various treatments for her IC (Interstitial cystitis), she heard I had treated a IC patient very successfully with acupuncture. She had urinary tract bacteria infection, which was recovered after the extensive antibiotic treatments, however, after that, she still has urinary frequency and strong burning pain when urination. She has been diagnosed as Interstitial cystitis, and then secondary developed Vulvodynia and pelvic bottom dysfunction.

When Ms.D. started to see me, she told me her physical therapist had treated her for several months. She had many trigger points and knots around the tail bone, anus and beside vulva, both thighs inner side.

After six sessions’ acupuncture, included in local A’shi / trigger point treatment and adjusting liver, spleen, kidney meridians, patient’s pain has been improved 60%, most of trigger points and knots at both thigh and around tail bone disappeared. The urinary frequency still there, the burning pain decreased. Patient is very happy and still under our treatment, twice a week.

Here is another article from online, for your information.

Vulvodynia and Acupuncture Treatments

By Maryann Child, Acupuncture Physician
www.coralspringsacupuncture.com 

http://www.vulvodyniasupport.com/acupuncture.html

Vulvodynia is a condition, which few in the medical profession have yet to resolve or even understand. Little research exists and little is known about its origins or how best to treat it. What does seem apparent is that for those women who do have it, it is a constant daily dis-ease. Characteristics of Vulvodynia may vary from woman to the next, what is very certain is that there is usually pain and possible burning of the vulva. The level of pain can change from mild to severe. The etiology behind the condition may vary from one woman to the next, so differential diagnosis is essential for individual patient care. This differential diagnosis is what sets Chinese Medicine aside from Western Medical approach. Two women with the same diagnosis may have completely different disharmonies, so treatment is very unique to the patient’s personal body care.

Acupuncture may be a treatment option for Vulvodynia and Vestibulitis. In the proceedings workshop sponsored by the US Dept of Health in collaboration with the National Institutes of Health, National Institute of Child Health and Human Development, Office of Research on Women’s Health, and the National Office of Rare Diseases on April 14-15, 2003, discussion on the lack of understanding and research on the subject of vulvodynia was addressed. Dr. Elizabeth Stewart, of Harvard University had stated that physical therapy might alleviate the vulvar pain that was referred from the ligaments and joints in the spine and pelvis. One study did confirm that patients that used acupuncture to alleviate the pain showed improvement, and over all quality of life. She also did state that surgery for Vestibulitis was highly controversial because of the lack of clear pathophysiology for vulvar pain. There was great concern over cosmetic results. The overall consensus is that there is a relationship to the pudendal nerve being pinched. In Europe and in pain centers in the US, decompression of the nerve is attempted. Acupuncture is a great alternative to relieve compression of this nerve, and to strengthen overall system health.

Acupuncture is part of an ancient system of healing which incorporates all aspects of the physical and non-physical bodies. It is part of a larger doctrine called Oriental Medicine or Traditional Chinese Medicine. The belief is there is a vital energy that surrounds all living things. We call this “qi” or “prana”. It seems that just about every ancient culture has a name for it. We all recognize it as being real and existing. Even allopathic, western medicine has a name for it “vitality”. It is within this energy that the practitioner works his or her art. Constantly changing and creating harmony where there is disharmony, tonifiying what has been depleted and rectifying what has been in exuberance. The I ching states that all things are constantly changing and that nothing stays the same. This is the beauty of life. Every practitioner counts on this change to occur. After every treatment one anticipates the positive change in the body, hoping to rectify its disharmony. Acupuncture points are small areas of energy that spiral round, each with a different action and indication. These small energy spirals travel a pathway, which for the most part connect to an internal body organ. However there are other pathways that do not connect to any organ, these are referred to as extra ordinary pathways. Then lastly there are smaller pathways that diverge from the larger ones and cross the body. These smaller pathways allow for even the smallest communication between energy and body. The insertion of a needle into an acupuncture point creates communication between the function of the point and the body’s energetics. The formulation of points creates a reaction in the body. The body accepts the information and begins a cycle of change. Cycles of change can vary from one body to the next. Gradual improvement of symptoms is what is expected.

In Traditional Chinese Medicine the body is viewed as having patterns of harmony and disharmony. A practitioner pays very careful attention to what the condition of the body is. One examines closely what the blood is doing, what the “qi” is doing, and what it is not. The practitioner further seeks to determine where the patterns of disharmony exist. Differential diagnosis is attained and treatment to restore the body is begins. Women’s bodies are so diverse, that there are no two bodies alike. With treating Vulvodynia, I have noticed that even though there may be some similarities between patient’s symptoms, their etiologies or rather the root cause of the disorder is very different.

I first became aware of this disharmony about five years ago around the year 2000. I began treating a young patient who complained of sheer fire burning of her external genitalia. I remember feeling a bit puzzled because I had not heard of such a condition, so naturally I began to do some research. Very few of my colleagues had even heard of it. No one in my area had ever treated it. With this I began her treatment protocol.

The response that I have seen from my patients, lead me to believe that VV is completely treatable and I will explain why. I will cite two examples of patients that were treated with Acupuncture. What follows are two brief patient cases that were treated with Acupuncture. I’d like to mention that both patient’s are still receiving treatment, and are still obtaining very favorable results.

Mrs. P is a 35-year-old non-smoking married woman who was recently given a name to her burning and stinging of the vulva. For the past two years she has been treated for urinary tract infections. She has a history of low back pain and migraines. Although her migraines were a big concern for treatment, even more so was the constant irritation of the vulva. Mrs. P had a total of four treatments over the course of one month before significant results were obtained. Currently Mrs. P still comes in for treatment one time a month occasionally twice a month. Mrs. P is still undergoing treatment and is about 60 to 70 percent improved. There are many days where she is free from burning and stinging. She can remain free of discomfort for many weeks at a time.

Miss. M is a 49 year old, non-smoking non-married woman who was diagnosed
with Vulvodynia over the summer of 2004. The pain started in 2003, but was recently given a diagnosis. Her major complaint is pain of the vulva. The pain is drawing in nature. The pain is worse while sitting and better lying down. Mrs. was initially treated with Chinese herbal formulas that were modified specifically for her disharmony. Three weeks into treatment she began to feel improvement of her symptoms. Initially her improvement was minimal, then gradually began to feel better. Currently Mrs. M is treated every 4 to 6 weeks.

I wish to express my very concern for the lack of study on VV and treatment. Many women that I have seen have informed me of different experimental procedures that their Dermatologist, Gynecologist and Neurologists have mentioned. I say experimental because there is no significant data to show proof of success. I have even heard of a new use for botox. Injecting botox was the latest that I have heard this week. This is a desperate attempt in the medical world. Although there is no concrete evidence of a cure, in any medical model, all physicians would like to see a resolution of Vulvodynia. I hope if nothing else to bridge the gap between a woman and her options for treatment.