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Posts Tagged ‘舞蹈病’

1. One gentleman who lives in LA visited me in last week. He has mouth and tongue (etc.) dystonia for many years. He has Botox injections, which helped to diminish the symptoms in some extents. The patients had one month herbal tea (we mailed herbs to him) and two months’ capsule, as well as 20 sessions’ acupuncture (in LA).

His personal experience is acupuncture (did in LA by a local acupuncturist) did not help him very much, the herbal tea seems help his more. During the herbal tea treatment (with acupuncture), he had more relieve in dystonia. He had acupuncture in our office once a day for three days, during that short period, we did not find a significant improvement.

He decide to use herbal tea and acupuncture for a few months and see if Chinese medicine could help him to overcome his dystonia.

Dr.Fan notes: Some of patients may respond the herbal tea better than that in acupuncture.However, some patients have better response in acupuncture. Basically, I recommend acupuncture plus herbal tea. Some time the capsule LIU JUN SAN also plays a good rule.

2. One middle age woman who has neck dystonia, or we call it Crooked, Twisted Neck Cervical Dystonia, or Spasmodic Torticollis (ST). She had to use muscle relaxant and 4 or more tablets of Ibuprofen everyday. After our acupuncture (with LIU JUN SAN capsule) for about 8 sessions, she could have 4 to 5 days pain relief (still use muscle relaxant) per week, and dystonia very less (self report “50% improvement”). She still uses Ibuprofen in 2-3 days/week, but the amount drops to 2 tablets a day. She is still in treatment–acupuncture, twice a week. Due to some reasons, she does not use herbal tea.

3. One young man with Spasmodic Torticollis who lives in Columbia, had Botox injection which leads a partial symptom relief. Using herbal tea and LIU JUN SAN one treatment course(one month), he feels better. So we decide to start the second course herbal tea plus LIU JUN SAN capsule today.

4.One young woman with both hands/fingers dystonia(right hand worse). She has used Botox injection for long time. She has seen me for three years and has used LIU JUN SAN capsule in some times. Yesterday, she came again and still just for LIU JUN SAN. Her experience is LIU JUN SAN capsule helps in eliminating the partial dystonia which Botox injection does not work, i.e. She feels Botox injection plus LIU JUN SAN capsule help more than Botox alone.

5. Three women with Spasmodic Torticollis who had acupuncture here for many years and recovered very well, still come for “tun up” acupuncture, i.e. once 2 weeks or one month. Still using LIU JUN SAN sometime as maintaining treatments.

Dr.Fan notes: Acupuncture at least could work on relaxation, adjusting the neurological function(such as work on Dopamine system,etc), as well as treating the pain and spasm from dystonia. Herbology is more complicated, according to our data, our special herbal formula for dystonia (“tea” and capsule) could diminish the dystonia and very stable.

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See detail, click the link:

http://www.youtube.com/watch?v=cOE19MfFStY

www.ChineseMedicineDoctor.US

For more Videos, please click:

http://www.youtube.com/my_videos?feature=mhw5

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Patient’s e-mail:

-On Sunday, October 24, 2010 1:30 PM

From:”L. M.” <l…..@hotmail.com>
Dr Fan,
Thank you for checking on us.  My daughter’s condition, after 6 months taking Liu Jun San & herbal tea, has been stable. She seems to have better balance, and her dystonia has been really mild. I’d like to see if she can maintain this condition without the help of medication.

I’d like to thank you for helping my daughter getting such a great improvement! I’ll keep you in touch.

Best regards,
L.

-On April 23, 2010

 RE: J….. 9 yrs old with dystonia

Friday, April 23, 2010 6:30 PM

From:”L. M.” l….@hotmail.com
To:
Dr. Fan,
 
My daughter has been taking Liu Jun San capsules and herbal tea for almost two months by now, and she’s got a really big improvement. Her facial tics (eyes and mouth) is like 99% gone. The dystonia on her foot is getting milder. Her foot is not stiff and turn in anymore. She now walks way better and faster. Teachers at her school also notice this big improvement because before walking was really hard for her, they even discussed about getting my daughter on wheelchair to help her go around the school.  But now we don’t think she needs one.
Some teachers were amazed with the result, they asked what I’ve given to my daughter and I gave them your name and your website.  
 
Thank you so much for bringing back my daughter’s confidence. Now she enjoys walking again, and she doesn’t come home from school in tears anymore because walking is so much easier for her now. 
 
I would like to order one course treatment again. I will fax my new credit card to you, please kindly let me know once you receive the fax.  Once again thank you!!
 
Sincerely,
L.

Patient’s e-mail:
— On Tue, 3/23/10, L M wrote:

From: L.M.
Subject: RE: J……, 9 yrs old with dystonia
To: “Arthur Fan”
Date: Tuesday, March 23, 2010, 12:39 PM

Hi Dr Fan,

J…. has been taking the capsules & herbal tea since March 02, 2010. Her facial tics (eyes & mouth) getting much lesser, and she does not complain a lot of headache anymore. As far as the foot there’s a little bit improvement, but I believe there will be so much more improvement as she continue taking the medicine. We are so grateful to find you, because not many people understand dystonia well, even doctors, acupuncturist. I feel so thankful that I could give my daughter natural treatment everyday. And I will still be making effort to take her to your clinic to get acupuncture.

Her neurologist thinks she may be a DTY1 dystonia (something genetic although none in our family has dystonia). In your experience, will it make harder to treat?

Also I will start to use Automatic Medicine Cooker. Will the cooking method and measurement be the same as the one on the paper? Please let me know.

Dr Fan, thank you. May God bless you more and more everyday, so people with dystonia like my daughter always have a hope- to be clinically cured.

I will be contacting you later to order more treatment.

Sincerely,
L.

Dr.Fan’s reply e-mail on 03/23/2010, at 21:00:

Dear L…..,

I am very happy to get your e-mail, and know your daughter has some improvements.

Just keep using the herbs. When she almost finish the herbs, you could let me know, see if we need some adjustments for her.

For automatic cooker, it will save your effort. Not necessary to follow the rule in our instruction. Just putting herbs, adding proper amount of water, turning on electricity, the setting Quick or slow cooking option, after one hour or so, it is done. It will keep warm until you turning off it or automatically turning off at about 3 hours.

For DTY1, or other type of dystonia, we did not have experience to compare the effectiveness, so I could not say anything about that.

Have a good day!

Arthur Yin Fan, PhD,CMD,LAc
McLean Center for Complementary and Alternative Medicine, PLC
8214 Old Courthouse Road, Tysons Square Office Park,
Vienna, VA 22182.
Phone:(703)499-4428; Fax:(703)547-8197
Web: http://www.ChineseMedicineDoctor.US
Blogs: http://www.arthuryinfan.wordpress.com

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02/24/2010

Dr. Fan has recently been busy treating patients with different forms of dystonia from the United States, China and India.

One patient from North Carolina (NC) drove 7.5 hours and is living in a hotel near our office for a short-term for acupuncture treatment.  http://www.youtube.com/watch?v=zJjFopYP

ONE Patient S.P., 72 years old, has had dystonia for 13 years, initially it was cervical dystonia (Spasmodic torticollis), but 3.5 years ago it improved and became Spasmodic Dysphonia (abductor type). Her voice is strained, strangled, choked like, sound hoarse, breathless, anxious or groaning. Also, she has difficult in chewing, but no problem at swallowing.

She had Botox injections for 2 years (each helped about 3 months to some extent). Currently she is using some medications. However, she still finds it very hard to speak. Most of her words could not be understood. So her sister helps her as an interpreter.

To date she has had 3 acupuncture sessions in our office. Both she and her sister feel there has been a great deal of improvement, although she still has a spasmodic voice, her words are basically understandable. We took a second video today and her the difference between initial visit and today. She is very happy with the result.

She plans to treatment for two more days. She plans to come back in near future (after going home to assess the results).

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Written by Dr Helen Hanson, Movement Disorders Unit, King’s College Hospital, London and Dr K Ray Chaudhuri, Movement Disorders Unit, King’s College Hospital, London

Primary dystonias

Generalised dystonia

This is also known as primary torsion dystonia or dystonia musculorum deformans. The usual age of onset is between 5 and 16 years. Parents or teachers may notice an abnormal turning in of the foot, an awkward gait or contractions of many different muscle groups.

The involuntary dystonic movements may progress quickly to involve all the limbs and torso, but the rate of progression usually slows after adolescence.

A genetic basis for generalised dystonia has now been confirmed.

Focal dystonias

Spasmodic torticollis

Torticollis, commonly called wry neck, is the condition of spasm affecting the muscles of the neck, causing the head to assume unnatural postures or turn uncontrollably.

Spasmodic torticollis, also known as cervical dystonia, is the most common of the focal dystonias. There are thought to be 10,000 people in the UK suffering from this condition.. The average age of onset is in the early 40s and more women are affected than men.

The head may tilt (laterocollis) or twist to one side (rotational torticollis), forward (anterocollis) or backward (retrocollis). The movements may be sustained or jerky (myoclonic torticollis). Muscle spasms or pinching nerves in the neck can be very painful. The neck may eventually be held permanently in one position.

Torticollis usually develops gradually. At first, the patient may notice that the head turns during everyday activities. In about a quarter of patients the hand may also develop some tremor, especially if trying to correct the involuntary movement. The tremor is common but not usually disabling and is referred to as an enhanced physiologic tremor.

The severity of torticollis can vary and may be worse if the patient is under stress. Occasionally drinking alcohol can improve the torticollis.

Some sufferers have a history of head or neck injury, but as yet there is no evidence to support the theory that torticollis is directly related to trauma.

Most patients find the condition deteriorates over the first five years, but their symptoms then stabilise. One third of patients progress to a segmental dystonia, usually involving the arm. The symptoms of about 10 per cent may stop spontaneously, but then later recur.

Patients with torticollis often find that their daily lives are affected. Head turning can prevent a proper view of the road when driving, it may become difficult to eat, brush teeth or apply makeup. Many sufferers find embarrassment and anxiety the major handicap.

Blepharospasm

Blepharospasm means the involuntary contraction of the eyelids, leading to uncontrollable blinking and closure of the eyelids.

It affects more women than men and in the UK and it is the second most common focal dystonia with approximately 4000 people affected. In very extreme cases, sufferers are unable to prevent their eyes from clamping shut so that despite normal vision they are functionally blind.

Muscles in the face can also become affected causing facial distortions and grimacing when the patient attempts to open her eyes.

Blepharospasm usually develops gradually. The first sign a sufferer may notice is eye irritation and discomfort, light sensitivity and increased blinking. They may find that the condition worsens when they are tired, under stress or reading. Bright flickering lights, smoke or wind can all irritate the condition making symptoms worse.

Hemifacial spasm

Hemifacial spasm causes muscles on only one side of the face to contract. It affects both men and women and usually develops in middle age. More than 4000 people in the UK are thought to be affected.

Hemifacial spasm develops gradually. Initially the muscles surrounding the eye may be affected by muscle spasms, which continue to spread and affect other muscles on the same side of the face, especially the jaw and mouth. Some patients may experience a clicking sound in the ear on the affected side each time a muscle contracts.

For unknown reasons hemifacial spasm tends to affect the left side of the face more often than the right.

The cause of the spasm may be related to the irritation of the nerve that controls the muscles of facial expression called the facial nerve. This may be due to an abnormally placed blood vessel at the back of the brain, near where the facial nerve arises. So hemifacial spasm may not be truly a dystonia.

Oromandibular dystonia

In this form of dystonia the jaw muscles, lips and tongue are affected causing the jaw to be held open, clamped shut or forced to deviate to one side.

The tongue may be pulled forward, upward, backward or downward.

Sufferers experience problems eating swallowing or speaking. Occasionally, this may be drug induced. Ulceration of the tongue may also occur due to a continuation of dry mouth and tongue twisting.

Orofacial-buccal dystonia

This dystonia is also known as Meiges or Brueghels syndrome. It is a combination of blepharospasm and oromandibular dystonia.

Spasmodic dysphonia

Spasmodic dysphonia (difficulty in voice production) is slightly more common in women than in men and occurs in middle age. The muscles affected are those controlling the vocal cords. Sufferers find that their voice sounds strained and strangled, that it takes a lot of effort to speak and that their voice comes out as tremulous, weak or a breathless whisper.

There are basically two types of spasmodic dysphonia. In the adductor type, speaking causes involuntary excessive muscle contraction of the muscles that bring the vocal cords together. This causes a strained, strangled, choked voice quality, often with abrupt initiation and termination of voicing, resulting in a broken speech pattern. The patient may sound hoarse, breathless, anxious or groaning.

In the abductor type, there is an overcontraction of the muscles that separate the vocal cords, resulting in a choppy and breathy whispering voice pattern.

Spasmodic dysphonia may follow an infection of the respiratory tract, injury to the larynx or a period of excess voice use.

Most patients find that they are able to use their voices normally in some situations. Patients with the adductor type may be able to laugh, whisper or sing normally. Improved speech is noted during emotional or physiological states for example joy, anger or following yawning. Shouting or stress usually makes the condition worse.

Writer’s cramp

In this type of dystonia the muscles of the hand and forearm are affected. Contraction or extension of the hand and finger muscles prevents activity or causes an exaggerated posture.

The patient complains of tension and discomfort. They might start to grip the pen too tightly and the script becomes slow and untidy. After a few words the patient is forced to stop and rest. The contraction disappears on stopping writing.

Occasionally the hand dystonia may also be associated with a tremor known as dystonic tremor. Sometimes a primary writing tremor may be mistaken as writing cramp.

Patients often employ trick manoeuvres to overcome the cramp. Some support their writing hand with their opposite arm, use thick nibbed pens, alter their grip or hold the pen in a closed fist. Unfortunately the cramp may arise in the other hand. Patients also find that they begin to have problems with holding other utensils such as forks and knives. Occasionally, the dystonia may be preceded by trauma to the limb.

There are other focal dystonias that are associated with a particular activity or occupation. Examples include typist’s cramp, pianist’s cramp and golfer’s cramp.

Adult-onset primary dystonia

This is a rare subtype of focal dystonia. The symptoms remain localised to the trunk of the body, but may spread to involve the neck muscles. The dystonia does not spread to the leg. Unlike other forms of focal dystonia it is more common in men than women.

The twisting trunk movements have been likened to the Leaning Tower of Pisa, and the term Pisa syndrome is occasionally applied to these dystonias.

‘Dystonia-plus’ syndromes

Dopamine, (often called ‘dopa’ which is in fact an intermediate chemical in dopamine’s production) is a chemical messenger widely used in the nervous system in passing nerve impulses between nerve cells (neurotransmission). Dopa-responsive dystonia is an important form that can be successfully treated with drugs such as levodopa (eg Madopar, Sinemet). Typically it begins in childhood or adolescence and leads to progressive difficulty in walking and in some cases spasticity (limb stiffness). The symptoms may fluctuate during the day from relative mobility in the morning to increasingly worse disability in the afternoon, evening and after exercise.

This is an important condition to recognise as treatment can result in dramatic improvement in symptoms.

Myoclonic dystonia is a rare type combining dystonia and sudden muscular spasms (myoclonus). The onset is in adolescence or early adult life. It mainly affects the arms and body. These patients can be very sensitive to treatment with alcohol and a genetic basis has been suggested.

Secondary dystonias

Secondary dystonias are often accompanied by other neurological problems. They begin suddenly at rest and are associated with different hereditary and environmental causes. Environmental causes include head trauma, stroke, a tumour, multiple sclerosis, infections in the brain, injury to the spinal cord, or after chemotherapy, drugs or toxins that affect the basal ganglia, thalamus or brain stem.

They may be associated with other hereditary neurological syndromes. Dystonia may be the first sign in a patient with Huntington’s disease, and is secondary to many other neurological diseases. These include Parkinson’s disease, Wilson’s disease and Ataxia telangiectasia. Examples of metabolic disorders causing secondary dystonia are Lesch-Nehan syndrome, Niemann-Pick disease and Leigh’s disease. All of these causes are rare.

What drugs can cause dystonia?

Certain drugs have been implicated in causing dystonic reactions or dystonia. This form of dystonia is referred to as secondary or drug induced dystonia. Some drugs may not cause dystonia but may aggravate the pre-existing disorder. Patients should avoid these drugs.

The list of drugs causing drug induced dystonic reactions is long but includes:

In general, alcohol does not have an adverse effect on dystonia but it is rarely seen to hasten it. Alcohol may also help dystonia, particularly forms of myoclonic dystonia. People who chronically abuse alcohol can get a series of involuntary movements or tremors not related to dystonia. Excess alcohol intake is not advised.

Is dystonia hereditary?

It has long been thought that there is a genetic or hereditary link to dystonia, as relatives of patients suffering from dystonia often also have some kind of tremor or dystonia and this link has now been identified in some types of dystonia.

Childhood dystonia (early-onset primary torsion dystonia or dystonia musculorum deformans) is often inherited through one or more affected/mutated genes.

If a parent has this type of dystonia, there is a 50 per cent chance of passing the gene to their children. The gene is on chromosome 9 and known as DYT1. (This mutation has been observed mainly in Ashkenazi Jews.) However, even if the child inherits the gene, they may not necessarily develop dystonia. This is known as reduced penetrance. In the UK about 40 per cent of people with the affected gene develop dystonia.

Research has shown that the gene DYT1 codes for a newly recognised protein called Torsin A. Its function is unknown. However, large amounts are concentrated in an area of the basal ganglia called the substantia nigra pars compacta, suggesting it has a role in dopamine neurotransmission.

Late-onset primary torsion dystonia or focal dystonia is inherited in a more complex manner than the early-onset dystonia. Genes known as DYT6 on chromosome 8 and DYT7 on chromosome 18 may be involved. These genes also have reduced penetrance so only about 12 per cent of people with the affected gene develop the dystonia. DYT6 has been found in people whose neck or head muscles are affected causing problems with neck, speech or facial muscles. DYT7 has been found in those mainly affected with myoclonic torticollis.

Dopa-responsive dystonia also has a genetic basis. Many patients have a mutation in a gene known as GCHI (GTP cyclohydroxylase) on chromosome 14. There is a 50 per cent chance of parents passing on the gene, although with reduced penetrance. However, it occurs more in women. Mutations in this gene cause abnormal production of a chemical called tetrahydrobiopterin, needed to produce the neurotransmitter dopamine. The drug levodopa is helpful in treating this form of dystonia as it increases dopamine levels in the brain.

Myoclonic dystonia also has a genetic component. A mutation in a receptor for the neurotransmitter dopamine has been found on chromosome 11 or 18.

See more, you could visit http://www.netdoctor.co.uk/diseases/facts/dystonia.htm

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Dear Dr. Fan, 

 I have seen some of your work with dystonia and Chinese Medicine on line.  My wife suffers from dystonia (mostly face and neck).  We are in Singapore presently and wonder if you could refer us to someone here in Singapore who might be able to follow your efforts and be of assistance to us.

Reply by Dr. Arthur Fan (e-mail) 

Dear Mr. A.T. 

I am sorry; I could not refer any acupuncturist or CMD I don’t know in Singapore.

If you like, the alternative way is you see a Chinese medicine doctor and give me your information, such as the history, tongue/pulse information, appetite, bowel movement information, etc.

Then I could mail you the herbs, pills, etc..

Arthur Yin Fan, PhD,CMD,LAc

Asking(e-mail)

Dear Dr. Fan, 

Thank you so much for your response.  Is there a clinic or hospital in Singapore that practices the same or similar medicine as you do that you would suggest we consider going to?  I know there are some possibilities in Chinatown in Singapore, but I don’t know if there is anyone that would have the same focus or experience that you might. 

Thanks, 

A.T.

Reply by Dr. Arthur Fan (e-mail) 

Hi, Mr. A. T.

In Chinese medicine, there are general practice and specialty practice. You may see someone who specialized in Chinese medicine neurology.

Sometime, the general practice may works also.

Arthur Yin Fan, PhD, CMD, LAc

Asking 

Dear Dr. Fan, 

Thank you for your past emails.  We appreciate them. 

My wife and I have relocated to the Delhi, India area, so we don’t have the current benefit of TCM in Singapore.  However, in a couple of days I plan to be in Kuala Lumpur, Malaysia and there want to secure a supply of Peony Root, Papaya, and Tian Ma.  I think I can obtain them. 

Can you tell us how these herbs should be used?  We don’t know anything about how to use them.  My wife is not very heavy–about 120 lbs., perhaps.  Also, she is still using some western medications (such as Amantadine, Valium (as a muscle relaxant), and I think also Pasatane) which we hope create no conflict.  (That was our concern in Singapore.) 

Also, if in Delhi we don’t have any regular access to acupuncture, can the herbs work on dystonia by themselves? 

We appreciate your advice.

Thanks.

Kind regards,

A.T.

Dr. Fan said: please don’t use herbs by yourself. Herbology is a specialty.

***NOTE: This patient came to Virginia to see me in last week.—-Dr. Fan notes.

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I have written and told dystonia patients: dystonia is only an outside manifestation (symptoms and signs) of inner side brain injury or degeneration / disorder at the basal ganglion area.  In theory, for structural brain damage, there is no way to “cure” this problem.  In conventional medicine, there are several drugs (including Botox) which could diminish the symptoms and surgery would try to injure certain normal areas to reach the balance. 

However, if you using Chinese medicine, after a long-term treatment, say more than half year, we may reach the balance and “clinically Cure” the dystonia (which means controlled very well).

We have had several cases of dystonia in China and in USA, after continuous treatments with acupuncture and Chinese herbal tea, where the patients’ dystonia symptoms are very, very occasionally obscure. You could basically could stop the acupuncture and Chinese herbology. But they do need maintenance, say acupuncture once every week or two, otherwise the symptoms returned (they should be mild treatments).

For the short-term acupuncture or Chinese herbal treatments, patients may get temporary improvements, but this may not create a stable cure.

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Dear Dr. Fan,                   02/18/2010

My name is L……  I have a 9.5 years old daughter who has dystonia since she was about 6 years old. The dystonia started with her right leg, and now also affect her left leg.
She also has mild dystonia on her eyes and mouth. Since the dystonia started, Josephine has been having problem with walking. Her feet turned inward and also stiff.
She walks very very slow, and her gait makes it even worse. She also gets a lot of headache.
Her neurologist prescribed her Artane for the dystonia, and she has been taking it until today.
 
I look forward to have alternative treatment such as acupuncture, and Chinese herbal medication. For right now I can not take her outside California to visit your clinic, but I am working on it to be able to take her seeing you. However, I would like her to get Chinese herbal medication and start taking it asap.
 
I am still working on having her video and sending it to you. Please respond to me about how we could get her Chinese herbal medication.  Her insurance will not cover this alternative treatment, so we will pay by ourselves. So please also let us know the cost of the medication.
 
Thank you very much for returning my call this morning. I have a very high hope after reading your website. I realize dystonia is not something that can be cured, but at least if it can be mild it will mean so much for my daughter’s life. Looking forward to hearing from you.
 
Sincerely,
 
L

The Reply from Dr. Arthur Fan 02/19/2010 9:00AM

Dear Lenny, 

That is correct. Almost all of treatments for dystonia in conventional medicine is symptom treatment (no cure). Using Chinese medicine, acupuncture plus herbs, it is also very hard to be cured in a short time. However, we do have some patients “cured”! 

That does the “cured” mean in dystonia? 

Answer: most of dystonia symptoms gone and just need mild herbal medicine or acupuncture maintenance. The treatment for that aim is at least 6 month to one year, or even more.

These treatments are not payable from your insurance in current time.  And you need patience.

Please give me her other information

Appetite, bowel movement condition, sleep condition.

Tongue color–coating (white? yellow? thin or thick) and tongue color(pink or very red),

Pulse (you could let a local acupuncturist have a look).

For more information, such as how much the fees for herbs, capsule, etc. You could read the detail online in my blog.www.arthuryinfan.wordpress.com(dystonia part)

Arthur Yin Fan, PhD,CMD,LAc

McLean Center for Complementary and Alternative Medicine, PLC
8214 Old Courthouse Road, Tysons Square Office Park,
Vienna, VA 22182.
Phone:(703)499-4428; Fax:(703)547-8197

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Today, one of my patients asked me–Dr. Fan, You are the Provider in My BlueCross BlueShield Insurance Network, Why I have to Pay Acupuncture Treatments?

Here is the answer:

Only when the patient has acupuncture coverage will the patient’s insurance “may” pay the acupuncture fee for patient. Why do I say “may” pay for?

It depends on a few conditions:

(1) If patient has an HMO, even if the patient does have acupuncture coverage, but the provider is not an in-network provider, the patient has to pay by himself/herself;

(2) If patient has PPO (with acupuncture coverage), and without limitation in deductible and illness condition, the provider also is an in-network provider, then insurance company should pay for the patient’s acupuncture treatment.

Should the patient have a PPO but without an acupuncture benefit, the patient will have to pay out of pocket. But the insurance may advise the provider to give such patients some extent discount/or just pay a reduced fee;

If the patient’s PPO has an acupuncture benefit, but has some pre-conditions, such as acupuncture treating the low back pain only, the patient will have to pay for acupuncture treating other conditions, such as upper back pain, neck pain, etc. If the patient has deductible, say, $500, or $1000, even acupuncture is covered, the deductible part has to be met first (paid for by patient prior to PPO paying).

And the co-pay (such as $25 or $40) or coinsurance part (such as 10%, 20% of the “allowed amount”, etc.) is the patient’s responsibility.

(3) Another issue is: insurance may cover acupuncture or electric-acupuncture only, other related therapies, such as Cupping, Tuina, Infrared, etc., in the theory, should be paid by patient. However, sometime, the provider may give patient a courtesy–at no additional fee.

Sometime, the flexible spending account could help patient to cover the part of self-pay, save patient’s tax in healthcare part.

Another very important issue is that if the patient has acupuncture benefit, most of the insurance companies define that acupuncture is only for chronic pain management, but some insurance plans are  for “acupuncture anesthesia” (which means only during surgery—actually this is a “joke” in the USA as there is not any licensed acupuncturist doing acupuncture anesthesia—the insurance company gives you a benefit which does not exist at all).

So, for acupuncture treating infertility, depression, etc. (without the pain), insurance will not pay for that.

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By invitation of the National Institute for Neurological Disorders and Stroke (NINDS) in Bethesda, MD, Dr. Arthur Fan (Fan Ying) recently lectured more than 20 medical doctors and clinical fellows on current progress, scientific studies, and clinical effectiveness evaluation in the treatment of movement disorders, especially Parkinson’s Disease, with acupuncture and traditional Chinese medicine (TCM).

As part of his Jan. 29, 2007 lecture on the National Institutes of Health (NIH) main campus, Dr. Fan showed videos demonstrating the beneficial effects of TCM on Meige’s syndrome (a dystonia) and Huntington’s disease as well as Parkinson’s. After the lecture, Dr. Fan answered questions regarding the placement of acupuncture needles in the body and scalp, the differences between manual and electric acupuncture, and the safety of using traditional Chinese herbology in neurological patients.

“In the treatment of movement disorders, which often diminish patients’ quality of life and are difficult to heal with Western medicine, TCM may dramatically improve patients’ lives by decreasing clinical symptoms in some cases,” says Dr. Fan. “For example, after acupuncture, the stiffness and shaking of extremities caused by Parkinson’s will often stop for many days. Also, TCM, including herbology and acupuncture, can improve patients’ sleeping and stabilize their emotions.”

Dr. Fan holds the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) certificate in Oriental Medicine, which comprises Acupuncture, Chinese Herbology and Asian Bodywork. This little-held certificate reflects his expertise in the use of Chinese herbs and therapeutic massage, as well as acupuncture, in the authentic practice of Chinese medicine.

Dr. Fan’s clinical practice is continually enhanced by his evidence-based research in TCM. In China he conducted research in his medical specialty areas under grants from the Chinese Nature Science Foundation. In the United States he has been an active scientific researcher in complementary and alternative medicine (CAM) under federal National Institutes of Health (NIH) grants. For the University of Maryland medical school, Dr. Fan is currently a consultant for the scientific study of TCM.

As an internationally noted TCM research scholar, he is also a CAM reviewing expert for several well-known medical publication houses including Elsevier and World Scientific. The recipient of several important awards from the Chinese government, Dr. Fan has been the subject of coverage by the international news agency Reuters Health.

www.ChineseMedicineDoctor.us

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If you are interested in reading more online about dystonia etiology, clinical features and treatments, there is a book here: http://books.google.com/books?id=bMKypn_B0tIC&pg=PA188&lpg=PA188&dq=dystonia+acupuncture&source=bl&ots=NQGwLxPXyM&sig=2r0ctp6cWWbcZgU-8TgQ6UnP0EQ&hl=en&ei=kiYDS8i8BNXVlAeendnuAQ&sa=X&oi=book_result&ct=result&resnum=10&ved=0CB8Q6AEwCTgy#v=onepage&q=dystonia%20acupuncture&f=false

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1.  Dystonia basically may be caused by a structural (mostly neuron) damage in the central nervous system (CNS), such as after a car accident or a head injury, there no way to be absolutely “cured”, most of the patients around world have to live with it; we did have “clinically cured” patients. But the treatment takes time, and not every patient could be cured–I mean, clinically. 

2. “Clinical cured” means the patient almost has no symptom and most movement is almost normal, but there may still be some that are slightly abnormal, because the CNS damage could not be fixed.  A normal MRI doesn’t mean having no neuron damage. If you are using an MRI, you may see more abnormalities. 

3. The treatment takes time, 8 session acupuncture treatments is one treatment course in our center (with or without herbal remedies). 8 sessions’ of acupuncture could never cure dystonia, I mean after 8 sessions, most of patients feel some effectiveness – some have more, some less and on rare occasions there is no effectiveness at all. 

4. In our blog before, we discussed the herbal remedy and the cost.  Herbal remedy may be very helpful in stabilizing the effectiveness. Acupuncture is quick, but herbal remedy is more stable. You could read more in www.arthuryinfan.wordpress.com dystonia part. 

5. If you feel some providers may have experience in dystonia treatment, you could see them; However, I could not predict the effectiveness. 

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Accession number;04A0915066

Title;Status of Acupuncture and Moxibustion: Interchange Between Basic and Clinical Studies: Effects of Acupuncture and Moxibustion on Muscle Diseases and Muscular Functions/Metabolism and the Status of These Techniques

Author;OZAKI AKIHIRO(Meiji Coll. of Orien. Med.) WAKAYAMA IKURO(Kansaishinkyudai Shinkeibyokense) TANAKA HIDEAKI(Pacific Wellness Inst., Ontario, Can) SUZUKI TOSHIAKI(Kansaishinkyudai Shinkeibyokense) SHIMBARA HISASHI(Meiji Coll. of Orien. Med.)

Journal Title;Journal of the Japan Society of Acupuncture and Moxibustion

Journal Code:S0406B ISSN:0285-9955 VOL.54;NO.5;PAGE.698-716(2004)

Figure&Table&Reference;FIG.6, TBL.1, REF.95 Pub. Country;Japan Language;Japanese

Abstract: In this seminar, the effects of acupuncture and moxibustion on muscle diseases and muscular functions/metabolism were reported, and the status of these techniques were summarized. In the clinical study section, it was reported that the effects of treatment on muscle diseases and muscular functions were evaluated using objective criteria, such as electromyograms. In the review of the methods for the evaluation of muscular functions using surface electromyograms, the static electromyograms, dynamic electromyograms, and power-spectrum analysis were presented, and the effects of acupuncture and manual treatment on diseases mainly in locomotor organs and their problems were discussed. For example, 72.9% of the 48 patients with cervical dystonia were found to show improvement by 10 courses of acupuncture treatment, and effects were observed in all patients by electromyography. Similar effects were obtained with patients with drug-induced dystonia. In many of the patients with writer’s cramp who underwent 10 courses of acupuncture treatment, improvement in writing tests, subjective evaluation, and the strength of pen stokes were observed. In the review of the basic studies, the effects of acupuncture, electroacupuncture, and transcutaneous electrical nerve stimulation (TENS) on muscular tension, muscular metabolism (energy metabolism, intracellular pH, lactate metabolism), muscular circulation, and noxious and non-noxious motor reflex were surveyed, and their mechanisms and problems were discussed. (author abst.)

Edited by Dr.Arthur Fan, www.ChinesemedicineDoctor.us

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A good article from Japanese Research for acupuncture treating dystonia

http://www.jsnm.org/files/paper/anm/ams201/ANM20-1-14.pdf

Acupuncture-induced cerebral blood flow responses in dystonia

Journal Annals of Nuclear Medicine

Publisher Springer Japan

ISSN 0914-7187 (Print) 1864-6433 (Online)

Issue Volume 20, Number 1 / January, 2006

Category Case Report

DOI 10.1007/BF02985597

Pages 83-87

Subject Collection Medicine

SpringerLink Date Thursday, November 13, 2008

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Case Report

Acupuncture-induced cerebral blood flow responses in dystonia

Sang Kil Ha-Kawa1 , Tsunetaka Yoshida1, 2 , Takasi Yague2 , Makiko Tani2, 3 , Toshiaki Suzuki2, 3 and Satoshi Sawada1

(1) Department of Radiology, Kansai Medical University, 10-15, Fumizono-cho, Moriguchi, 570-0074 Osaka, Japan

(2) Department of Neuropsychiatry, Kansai Medical University, Japan

(3) Research Center of Neurological Diseases, Kansai College of Oriental Medicine, Japan

Received: 24 January 2005 Accepted: 15 August 2005

Abstract

Objective The effect of acupuncture (ACP) on regional cerebral blood flow (rCBF) is unclear. Single-photon emission computed tomography studies on three patients with dystonia were performed before and after ACP treatment to test the contention that ACP affects rCBF.

Methods Pre-ACP and post-ACP CBF study were performed on the same day;99mTc ethyl cysteinate dimer was injected for each study. rCBF images were analyzed using a three-dimensional stereotaxic ROI template (3DSRT) to objectively measure rCBF. We evaluated rCBF bilaterally in five segments related to the pathophysiology of dystonia (1, superior frontal; 2, middle and inferior frontal; 3, primary sensorimotor; 4, lenticular nucleus; and 5, thalamus). More than 10% left-right asymmetry in rCBF over three continuous slices was defined as significant laterality. Post-ACP rCBF and laterality were evaluated with the pre-ACP rCBF study acting as a control in each subject.

Results The clinical effect of ACP was remarkable in all patients and rCBF increased in most segments. PreACP rCBF exhibited significant laterality in eight segments of the three patients. Laterality reversed in seven of these segments and resolved in the remaining segment after ACP. Pre-ACP rCBF laterality was not preserved in any segment after ACP. The remaining five segments exhibited laterality only after ACP. In total, after ACP, 13 of 15 segments demonstrated a change in CBF that was greater unilaterally.

Conclusions ACP results in an increase in CBF that is greater unilaterally. We think that unilateral change in CBF may be correlated with the action of ACP on the central nervous system in patients with dystonia.

Key words dystonia – acupuncture – cerebral blood flow

Dr. Arthur Fan www.ChineseMedicineDoctor.US

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转载请注明出处:http://www.1kum.com/pages/QJKolsln.html 

Edited by Dr.Arthur Fan, www.ChinesemedicineDoctor.us

 肌张力障碍(Dystonia)是一种不随意的运动。是一组由身体骨骼肌的协同肌和拮抗肌的不协调,且间歇持续收缩所造成的部分躯体重复的不自主运动和异常位置姿势的症状群。又称为肌张力障碍综合征(Dystonia Syndrome)。可由中枢神经系统器质性病变(如基底核病变)或不明原因引起,前者称为继发性肌张力障碍,后者称为原发性肌张力障碍。主要包括以下几种疾病:

 1.扭转痉挛(Torsion Spasm) 又名扭转性肌张力障碍(Torsion Dystonia)或变形性肌张力障碍(Dystonia Musculorun Deformans)。临床上以肌张力障碍和四肢、躯干甚至全身的剧烈而不随意的扭转为特征。肌张力在肢体扭转时增高,扭转停止时则正常。

 2.痉挛性斜颈(Spasmodic Torticollis)是由于颈部肌肉痉挛性或强直性收缩造成的一种头部旋转性姿势,颈部的深浅肌肉均可受累,但以胸锁乳头肌、斜方肌、三角肌及颈夹肌的收缩最为常见。起病缓慢,可发生于任何年龄,中年人起病多见。多见于锥体外系器质性损害。

 3.美基综合征(Meige Syndrome) 由法国Heury Meige医师(1910)首先描述,又称特发性眼睑痉挛,即口下颌肌张力障碍综合征,以双眼睑痉挛和口面部肌肉对称性不规则痉挛性收缩为临床特征。多见于中老年人,平均发病年龄为50岁,男女比例为1:2~3,30岁以前发病者少见。

 4.手足徐动症(Sthetosis) 又称指划运动、易变性痉挛(Mobile Spasm),它是一个综合征,为多种神经系统疾患的一种表现,是一种由不自主运动和异常姿势复合在一起的一种异常运动,临床以肌强直和手足发生缓慢不规则的徐动为特征表现。根据其受累部位可分为偏侧性和双侧性。

 中医学文献中无上述四种病患的具体论述,根据其临床表现,可归属于中医脑病中的“痉病”、“瘛疭、“搐搦”、“风搐”、“筋惕肉瞤”等病证范畴,历代有关记载较多。如《诸病源候论》曰:“筋不得屈伸者,是筋急挛缩,不得伸也。”所述症状与本组病证有相似之处。《景岳全书·痉证》认为:“凡属阴虚血少之辈,不能营养筋脉,以致搐、挛、僵仆者,皆是此症。”指出本组疾病由阴血不足、失于濡养所致。《证治准绳·七窍门》云:“谓目睥不待人之开合而自牵拽振跳也,乃气分之病,属肝脾二经络牵振之患。人皆呼为风,殊不知血虚而气不顺,非纯风也。”指出肝脾气血亏虚,血虚生风,虚风上犯清空,扰乱头面经脉,气血流行失常,是形成以上病证的主要病因病机。

 西医目前对肌张力障碍的症状控制尚无特效方法,主要采用症状局部注射肉毒杆菌毒素、脑深部电刺激以及一些对症治疗的药物,中医在辨证论治的基础上,加上辨病用药,对于减轻病情有一定的疗效,部分患者可以临床治愈。 

 薛必贞等治疗痉挛性斜颈1例,认为其病因为气虚血瘀,风痰阻络,治以益气活血,化痰熄风,药用黄芪、丹参、白芍、薏苡仁各30g,当归、桃仁、红花各10g,川芎6g,赤芍15g,党参、半夏各12g,甘草3g o.每日1剂水煎服,同时停用奋乃静:,安坦减量至逐渐停用,1周后痉挛症状明显减轻,继续服用1个月,患者舌质稍红,舌苔减少,考虑为久病伤阴,且长时间应用化痰、祛瘀药,有耗阴伤正之弊,遂在原方基础上加生地黄、麦冬各15g,将甘草改为炙甘草10g,另加鸡子黄2枚冲服,取“大定风珠”之义,再继续服药2个月,颈部痉挛症状消失,复查脑电图正常。总疗程半年,痊愈。随访半年未见复发。 (薛必贞,薛轴.中医药治愈痉挛性斜颈l例.山西中医,1992<3>:36)

 陈幸生针刺治疗1例7岁患儿,辨证为肝血亏损,肝风内动,窍闭神匿,选人中、风府、后溪为主穴,取华佗夹脊、上廉泉、肩髑、外关、合谷、阳陵泉、足三里、三阴交、太溪为配穴。操作方法:人中用雀啄法,行针1分钟,风府向咽喉方向斜刺1.5~2寸,患儿出现触电感后(身体抖动)即出针,后溪向劳宫透刺,外关透刺内关,肩髑透刺极泉,阳陵泉透刺阴陵泉,均用捻转平补平泻法。上廉泉用1.5寸针向舌根方向行鸡瓜刺,不留针。足三里、三阴交、太溪均直刺行捻转补法。华佗夹脊用1.5寸针略向脊柱方向斜刺,行捻转泻法,主穴每天必用,其他穴位交替使用,留针30分钟,10分钟行针一次,每日治疗1次,6次为一疗程。疗程间隔1天。经用上方治疗5天后患儿扭转略有好转,夜间能人睡5~6小时,饮食增加,余症同前。3个疗程后病情显著改善。遂用上方去风府、足三里,加哑门、委中,继续治疗1个月,扭转痉挛,挤眉弄眼,口角抽动诸症消失,言语基本正常,四肢肌力达V级,肌张力正常,痊愈出院。(陈幸生.针刺治疗扭转痉挛综合征.针灸临床杂志,1995<10>:38)

 章薇等以针刺阳陵泉为主治疗扭转痉挛,并设足三里组为对照组。主穴:阳陵泉或足三里(双)。辨证取穴:①气虚血瘀取气海、百会、三阴交、血海、脾俞。②阴虚阳亢取太溪、太冲、三阴交、风池、肝俞、。肾俞。③风痰阻络取风池、丰隆、行间、公孙、阴陵泉、脾俞。④气滞血瘀取膈俞、血海、太冲、合谷。⑤气血亏虚取脾俞、血海、三阴交、气海。观察组以阳陵泉为主穴,对照组以足三里为主穴,辅以辨证取穴,针刺上、下午各1次。用30号10cm毫针深刺6cm,快速进针,快速小幅度捻转1分钟,留针30分钟,拔针前重复操作1次,1个月为一疗程,两组均治疗2个疗程。结果表明阳陵泉治疗扭转痉挛作用明显优于足三里,临床效果良好。(章薇,利伍立,赵艳玲.针刺阳陵泉为主治疗痉挛性瘫痪52例临床观察.中国医刊,1999<3>:52)

 马臣针刺治疗右侧扭转痉挛1例,取穴:风池、合谷、丰隆、完骨(右)、扶突(右)、肩髑(右)、肩贞(右)、曲池(右),手法用泻法,留针30分钟,每10分钟行针一次,每日治疗1次,10次为一疗程,共治疗4个疗程,右肩抽动及头颈向左扭转完全停止,可从事正常工作。半年后随访,未见复发。(马臣.扭转痉挛案.中国针灸,1997(8):485) 

郭伦聪等用生脉注射液10ml,加10%葡萄糖注射液500ral,每日1次静滴,治疗因服用胃复安所致的扭转痉挛、痉挛性斜颈及手足徐动症。共治疗10例,7例在24小时内痊愈,3例在48小时内痊愈。(郭伦聪,柯明远.生脉注射液治疗胃复安所致锥体外系反应10例.福建中医药,1999<3>:封四)

徐明涟等采用中西医结合方法治疗扭转痉挛1例。中医治疗:证属阳虚湿阻,经气不利,筋脉失养,以附子汤合羌活胜湿汤加味治疗。药用:炮附子12g,党参20g,茯苓30g,白术12g,白芍30g,羌活12g,独活12g,防风12g,蔓荆子12g,葛根20g,黄柏10g,当归12g,川芎12g,水煎服。服28剂,症状明显缓解,仅感腰软无力,双下肢发凉怕冷,上方加狗脊12g、怀牛膝15g、五加皮5g以补肝肾壮筋骨,服18剂,诸证悉除,再予上方12剂继服以巩固疗效。西药治疗:患者微量元素检测提示血钙、锌偏低,遂予葡萄糖酸钙1g口服,每日3次;复合蛋白锌3片口服,每日3次;妙纳50rag口服,每日3次。共服2个月。痊愈出院后两个月患者来复查,完全恢复正常。(徐明涟,胡志强.中西医结合治愈扭转痉挛1例.中国中西医结合杂志,1996<12>:720) 

王东等根据Meige综合征的证候辨证施治,对4例患者用不同手法针灸治疗:1例取穴足三里、外关、曲池、完骨、风池、足三里用补法,完骨烧山火,余穴均用泻法;1例取穴足三里、血海、完骨、风池,手法同前;1例取穴足三里、合谷、养老、昆仑、风池、风府,用补法;l例取穴足三里、合谷、风池、风府、哑门,用补法。临床收到一定疗效。(王东,苏惠琳.针灸治疗Meige综合征4例.中国中医眼科杂志,1996<3>:158) 

徐福升等运用中西医结合疗法治疗Meige综合征。方法:黄芪注射液(成都地奥生产,每支2ml,相当于黄芪4g)16ml加入10%葡萄糖注射液300~400ml中静脉滴注,每日1次;复方丹参液(上海第一制药厂生产,每支2ml,相当于丹参、降香各2g)20ml加入5%的葡萄糖注射液250m|静脉滴注,每日1次,连用2周。同时给左旋多巴(每片250mg)250rag口服,每日4次,每隔2日增加500mg,到病情稳定时,维持治疗量,疗程2周。治疗2周,共治疗12例,治愈5例,有效7例。未发现药物的不良反应。(徐福升,陈方焘,徐哲.黄芪丹参注射液合左旋多巴治疗老年Meige综合征12例.安徽中医学院学报,1999(4):23)

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