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Posts Tagged ‘马里兰’

Jun 3, 2014 A Madam e-mail To ArthurFan@ChineseMedicineDoctor.US
Dear Dr. Fan,
I spoke with you recently over the phone about my diagnosis of oromandibular dystonia. You had asked that I send you some background, as well as my address to send an herbal remedy to that you have found works well for dystonia patients.

I was diagnosed around 9 years ago by two neurologists (Lahey Cliinic, Mass General) with task-specific oromandibular dystonia. I was doing radio broadcasting (weather reporting) for a couple of years, which involved repetitive phrases and likely- at least in part- brought on the condition. I first developed symptoms while doing the reports in a recording booth, although my conversational speech was normal (behind the microphone I had symptoms, and stepping away from the microphone I had no symptoms). The symptoms intensified over time and I eventually had to quit the broadcasting. My conversational speech eventually became impaired, and it took at least a year (or more) for the condition to go mostly back into remission. I stayed away from the broadcasting until around 10 months ago, and have only been doing a small amount of broadcasting (two hours or so) a week. I started noticing symptoms returning while working in a research lab (that is my primary job and where I spend most of my time). It was a stressful year for me, as I was trying to get a couple of projects finished so I could publish the work- I had invited a colleague of mine to be a co-first author on this work, and we ended up having many stressful, intense conversations about the work that involved constant voice projection (the lab is loud because of background noises). I’m not sure if it was a combination of stress/anxiety coupled with voice projection, and perhaps also coupled with the little bit of broadcasting I had started doing again that brought the condition back. I was also volunteering for a couple of hours a week at a preschool- which involved more voice projection. I first developed symptoms while in the lab, talking with my colleague.

Years ago when the dystonia first appeared, I received scalp acupuncture treatments based on a protocol published in a Chinese journal that showed success in 19 early Parkinson’s patients. This was successful in relieving my symptoms. I’m on the same protocol again and am receiving treatments three times a week. I had published an article in Natural Solutions Magazine (formerly Alternative Medicine Magazine) in collaboration with my acupuncturist. Below my signature is an excerpt from the article.

I was wondering if you could send me information that I could pass along to my acupuncturist that details the protocol that you use with your dystonia patients? I would also be grateful to receive the herbal remedy that you have found works well for oromandibular dystonia. My address is(omitted in this article):

Thank you kindly for your time.
Best wishes,
E
(Excerpt from the published article):
I had been placed on a Bell’s Palsy acupuncture protocol for several months, since this was- at the time- the only neurological disorder my acupuncturist was familiar with, and unfortunately one that is characteristically very different from dystonia. I was about to quit the acupuncture since it wasn’t bringing me any real benefit, when I asked her if she knew of any protocols used to treat Parkinson’s disease- the closest disorder to dystonia that I knew of. Although researchers have not found a direct link between dystonia and Parkinson’s disease, there is great interest in some of the symptom crossover, and research groups are actively trying to better understand the overlap between the two movement disorders. Since Parkinson’s and Dystonia are both neurological and result in similar signs and symptoms, it was possible that a Parkinson’s acupuncture protocol could be adapted to a dystonia patient.

My acupuncturist found a journal article that outlined a protocol that involves both body and scalp acupuncture, and which is used to treat Parkinson’s patients.1 Acupuncture can help relieve symptoms by altering blood hormone levels. In Traditional Chinese Medicine (TCM), Parkinson’s and dystonia are believed to be caused by genetics, aging, damage from excessive emotions, faulty diet, and chronic disease. Parkinson’s and Dystonia in TCM are seen as an inability of the blood and yin to nourish sinews and vessels, resulting in contraction, stiffness, and rigidity. The liver in TCM is what governs the sinews, and if the blood and yin become deficient, yang can become hyperactive, resulting in liver wind. These disorders mainly take root in the liver, but can lead to more complex presentations such as phlegm accumulation, qi and blood stagnation, and spleen and kidney deficiency. In TCM, you treat the root cause; in this case, treatment would involve settling the liver and extinguishing wind, and the manifestations, such as phlegm, stagnation, and/ or deficiency. One small study, An Acupuncture Protocol for Parkinson’s Disease,2 showed a total amelioration rate of 84.2 percent when scalp acupuncture was incorporated into an acupuncture treatment.

 

Arthur Yin Fan,CMD,PhD,LAc Jun 3,2014(E-mail) To A Madam (e-mailed me above)

Hi, E,

You may still use scalp and body acupuncture you mentioned. Take time. And also use some local points.

For herbal medicine, we have two:
(1) Pattern based herbology, heal tea.
(2) Dystonia focused herbal pills. It is called Liu Jun San capsule (100 capsule/per bottle, use 3#, 3 times a day).
It was a Chinese FDA (local branch) approved for hospital use (my former hospital).

 

A Madam Jun 3,2014 To Arthur Yin Fan,CMD,PhD,LAc

Dear Dr. Fan,

Thank you very much. I would like to try the dystonia focused herbal pills (if this is what you would recommend for my condition). I had seen a Youtube video of a gentleman with oromandibular dystonia that you had helped, whose symptoms looked (and sounded) identical to my own (lower left lip spasms, pursing of the lips, difficulty speaking). Did he take the dystonia focused herbal pills, or the pattern based herbology, heal tea?
Thank you again,

E

From: A Madam To: ArthurFan@ChineseMedicineDoctor.US
Sent: Thursday, July 10, 2014 8:19 AM
Subject: Request for more dystonia-specific herbal capsules

Dear Dr. Fan,
The herbal capsules that I received from you (Liu Jun San, 3 bottles in early June) seem to be working very well for me. My condition within two weeks of taking them went into a near remission. I still have symptoms, however my conversational speech has dramatically improved and I am even still able to do some radio broadcasting each week. I have also been doing scalp acupuncture, which might be synergistic with the capsules. I was also taking herbal teas prepared by my acupuncturist for several weeks prior to taking the capsules- She said there was some overlap in the ingredients in the teas versus what is in the capsules.

I would like to order another shipment of Liu Jun San for next month. I would actually be interested in continuing to take these capsules indefinitely, as I believe they might be effective in suppressing my symptoms. Is it possible for me to receive an automatic shipment every month, with the money taken out of my credit card each month automatically?

Thank you kindly.
Best wishes,
E

  • Jul 11 at 9:46 PM  To  Arthur Yin Fan,CMD,PhD,LAc
Wonderful! Thank you so much!
I was at a party this evening, by the way, and I was discussing my condition with someone. She said she never would have known if I hadn’t told her. I really am doing so much better- Thank you!
E
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Today, a friend told me she had acupuncture in our center for two and half weeks, lost weight 6 pounds.

Acupuncture adjusted her appetite and mood.

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Yesterday, a 44 years old lady came and hugged me very tightly for three minutes. And then told me she got pregnant naturally after my acupuncture treatment.

She said she should be my no.76 clients got pregnant–because she had seen there was a notes on the office board-75 pregnancy since 2007.

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J Sex Med. 2010 Feb;7(2 Pt 2):981-95. Epub 2009 Nov 12.

The ACTIV study: acupuncture treatment in provoked vestibulodynia.

Source

Elements of Health Centre, Victoria, Canada.

Abstract

INTRODUCTION:

Provoked vestibulodynia (PVD) is a distressing genital pain condition affecting 12% of women. Treatment modalities vary and although vestibulectomy has the highest efficacy rates, it is usually not a first-line option. Acupuncture has a long history in the traditional Chinese medicine (TCM) system and operates on the premise that pain results from the blockage or imbalance of important channels. The main principle of treatment is to move Qi and blood to cease genital pain.

AIM:

To explore effect sizes and feasibility in a pilot study of acupuncture for women with PVD.

METHODS:

Eight women with PVD (mean age 30 years) underwent 10 1-hour acupuncture sessions. Specific placement of the needles depended on the woman’s individual TCM diagnosis. TCM practitioners made qualitative notes on participants’ feedback after each session. Main Outcome Measures. Self-reported pain (investigator-developed), pain-associated cognitions (Pain Catastrophizing Scale [PCS], Pain Vigilance and Awareness Questionnaire), and sexual response (Female Sexual Function Index) were measured before and after treatment sessions 5 and 10. Qualitative analyses of TCM practitioner notes were performed along with one in-depth case report on the experience of a participant.

RESULTS:

A repeated measures analysis of variance revealed significant decreases in pain with manual genital stimulation and helplessness on the PCS. An examination of effect sizes also revealed strong (though nonsignificant) effects for improved ability to have intercourse and sexual desire. Qualitative analyses were overall more positive and revealed an improvement in perceived sexual health, reduced pain, and improved mental well-being in the majority of participants.

CONCLUSIONS:

Effect sizes and qualitative analyses of practitioner-initiated interviews showed overall positive effects of acupuncture, but there were statistically significant improvements only in pain with manual genital stimulation and helplessness. These findings require replication in a larger, controlled trial before any definitive conclusions on the efficacy of acupuncture for PVD can be made.

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My patients and many others sometime want to know what is the difference between IVF and acupuncture in infertility treatments.

Actually, the difference is significant.

1. IVF, using artificial procedure to help the infertility couple to get baby(s). It is a procedure with the external help(doctors) and get “pregnancy”, like a game.  And, sometime, using donor’s egg or sperm. The result could know in one month. If you see the patient has bleeding after some days post the procedure(embryo transferring), the IVF is failed.

2. Acupuncture, adjusts the hormones and improving the function, which makes patient become a normal people. And then she could get pregnancy in any cycle.

Yesterday, one patient told me she got pregnancy after our acupuncture treatments.

 

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Fertil Steril. 2012 Mar;97(3):599-611. Epub 2012 Jan 11.

Effects of acupuncture on pregnancy rates in women undergoing in vitro fertilization: a systematic review and meta-analysis.

Source

Institute of Integrated Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China.

Abstract

OBJECTIVE:

To evaluate the effect of acupuncture on in vitro fertilization (IVF) outcomes.

DESIGN:

Systematic review and meta-analysis.

PATIENT(S):

Women undergoing IVF in randomized controlled trials (RCTs) who were evaluated for the effects ofacupuncture on IVF outcomes.

SETTING:

Not applicable.

INTERVENTION(S):

The intervention groups used manual, electrical, and laser acupuncture techniques. The control groups consisted of no, sham, and placebo acupuncture.

MAIN OUTCOME MEASURE(S):

The major outcomes were clinical pregnancy rate (CPR) and live birth rate (LBR). Heterogeneity of the therapeutic effect was evaluated with a forest plot analysis. Publication bias was assessed by a funnel plot analysis.

RESULT(S):

Twenty-four trials (a total of 5,807 participants) were included in this review. There were no significant publication biases for most of the comparisons among these studies. The pooled CPR (23 studies) from all of the acupuncture groups was significantly greater than that from all of the control groups, whereas the LBR (6 studies) was not significantly different between the two groups. The results were different when the type of control was examined in a sensitivity analysis. The CPR and LBR differences between the acupuncture and control groups were more obvious when the studies using the Streitberger control were ignored. Similarly, if the underlying effects of the Streitberger control were excluded, the LBR results tended to be significant when the acupuncture was performed around the time of oocyte aspiration or controlled ovarian hyperstimulation.

CONCLUSION(S):

Acupuncture improves CPR and LBR among women undergoing IVF based on the results of studies that do not include the Streitberger control. The Streitberger control may not be an inactive control. More positive effects from using acupuncture in IVF can be expected if an appropriate control and more reasonable acupuncture programs are used.

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Acupuncture Today, April, 2012, Vol. 13, Issue 04      http://www.acupuncturetoday.com/mpacms/at/article.php?id=32551

Real Acupuncture or Real World Acupuncture? Deciphering Acupuncture Studies in the News .  By Matthew Bauer, LAc

Recent studies have concluded that acupuncture is no more effective than various forms of sham or placebo acupuncture, and these conclusions have been reported in the media and used by skeptics to discredit acupuncture.

The Oriental medical (OM) community’s response to these reports has been ineffective, perhaps counterproductive. These studies, and the resulting media coverage, can serve was a wake-up call to the OM community, alerting us that we need to be more proactive in our public education efforts and rethink some long-held beliefs regarding the efficacy of traditional theories.

In the News 

In the last few years, several studies sought to measure the effectiveness of acupuncture in treating common conditions.1,2,3 The findings of these studies were widely reported within the media.4,5,6 The good news for the Oriental medicine (OM) profession is that these studies found that acupuncture was not only effective, but often more effective than conventional therapies. The bad news is that these studies also found that traditional acupuncture techniques – based on the point/channel theories taught inOMschools – were no more effective than what is termed “sham” or “placebo” acupuncture.

The most recent of these studies, published in the May 11, 2009 issue of the Archives of Internal Medicine and sometimes referred to as the “Seattle” study, built on other recent studies and is a good example of current acupuncture research. One of the conclusions this study’s authors reached is particularly striking:

“Collectively, these recent trials provide strong and consistent evidence that real acupuncture needling using the Chinese Meridian system is not more effective for chronic low back pain than various purported forms of sham acupuncture.”

As someone who has treated thousands of people with chronic low back pain using the Chinese meridian system, my first reaction to this statement was to feel the researchers were mistaken. But, I also respect scientific research and feel it would be a great mistake for those of us in the OM profession to criticize these studies just because they tell us something we don’t want to hear, without looking critically at both the studies and our own beliefs.

Real Vs. Real World 

The only evidence these studies actually provide is that so-called “real” acupuncture is not more effective than sham acupuncture in a controlled, clinical trial environment. I believe this detail is of critical importance. But, before I explain why this detail is of such importance, I want to critique the response to these studies from within the OM profession.

Up to this point, the sparse response from theOMfield to these studies has been limited to pointing out that there are many acupuncture points including hundreds of extra points, so “sham” acupuncture is still hitting acupuncture points. Regarding studies that use “placebo” techniques in which acupuncture is simulated with the skin unbroken, some acupuncturists have pointed to tapping techniques, common in Japanese acupuncture, that never pierce the skin. While there is some merit to these arguments, they ignore the greater problem with these studies and make theOMprofession sound to the public like we are grasping at straws and making excuses. If researchers can’t help but hit useful points no matter how hard they try to avoid them, why should anyone bother seeking treatment from people trained in the complex traditional theories that stress diagnosing qi imbalances to identify the best point prescriptions?

The primary problem with these studies is not that researchers inadvertently performed real acupuncture when they attempted to do sham or placebo acupuncture, but that the real acupuncture seriously underperformed. Most of these studies show the real acupuncture groups to be somewhere in the 45-60% effective range. Only 45-60%? If I was only getting 45-60% positive effect for my patients, I would never have been able to build my practice and support my family for the last 23 years. Ask any clinically successful acupuncturist, and they will tell you for common pain problems like low back pain, the average range of effectiveness is somewhere between 75-85%.

Obviously, something about the design of these studies does not capture what happens in the real world when using acupuncture to treat these conditions. Unfortunately, we don’t have enough studies that reflect what happens in the real world because most of the money for research has gone to the “controlled” studies using sham and placebo controls, and the type of patient contact that happens in real world treatment is not allowed. None of these recent studies allowed the acupuncturist who did the needling to consult with the patient and choose points and techniques.

In most of these studies, a set of points were prescribed and used repeatedly regardless of the patient’s progress, or lack thereof. TheSeattlestudy was the only study that attempted to mimic actual practice by having a diagnostic acupuncturist see one group of patients before each treatment. This diagnostician chose the points to be used based on traditional diagnostic rationale, but then these points were passed along to the treating acupuncturist who did the actual needling.

Qi Interaction

Will it affect the outcome if the acupuncturist who inserts the needles is not allowed to interact with the patient and choose what points and techniques to use? It shouldn’t matter, if acupuncture only stimulates specific nerve endings, causing mechanical neuro-chemical responses within the body. But, if acupuncture actually works by manipulating qi, as its founders and supporters have claimed for more than 2,000 years, then there is very good reason to believe that the qi dynamic between the acupuncturist and the patient is an important factor that must be considered.

The first day I interned in the private practice of my school’s clinic director, he asked me to take charge of treating a very difficult case. When I balked and said I thought I was too inexperienced to manage such a difficult case, my teacher told me that my sincere enthusiasm created a positive qi that helped to offset my lack of experience. Over the years, I have come to believe the acupuncturist’s qi can be as important as the points themselves. Points do matter, but the effect these points elicit is influenced by the qi of the one stimulating them. Like yin and yang, there is a combination of both factors at play: different points have different tendencies regarding how they influence a patient’s qi dynamics, but that tendency is influenced by the qi of the person manipulating the points. Because this fact is rarely discussed in acupuncture circles, researchers have not taken this into account in their studies.

Skeptics have long contended that acupuncture only works if the patient believes in it (ignoring the effects of veterinary acupuncture or animal studies), but it may be more important that acupuncturists believe in what they are doing. The best practitioners with the highest success rates put everything they have into every treatment – into every needle or patient contact. We choose points and techniques because we believe they are very best for our patients, and that belief influences the effects of the points. Any acupuncturist who puts needles in a patient not believing it to be the very best they can do is inserting those needles with less than optimal qi.

Unlike administering drugs or performing surgery, which manipulates the body in a more mechanical fashion, influencing qi dynamics is more dependant on subtle factors, including the qi of the one doing the manipulating. This may sound like what skeptics call “woo-woo” – irrational, new age mysticism — but it is a key part of acupuncture’s traditional foundation and deserves consideration. Before jumping to conclusions about traditional concepts, we should encourage studies using acupuncture in a way that reflects what takes place in the real world. Let’s study what happens to patients when treated in actual clinic conditions with no blinding or controls, in which the acupuncturist does whatever their years of training and experience leads them to believe is the best they can do for each patient. Don’t limit them in their techniques and communication with the patient, because such limits are not imposed in real world practice. And don’t refer to acupuncture being done under research constrained controls as “real” acupuncture, because it does not resemble the manner in which acupuncture is done in actual practice.

These studies point to sobering realities theOMprofession needs to face. We cannot ignore the fact that in study after study in which researchers stimulated points in a manner that seemed incompatible with traditional Chinese medicine protocols, a respectable percentage of test subjects experienced significant improvement. So while it may be fact that the best trained and most experienced acupuncturists will obtain 75-85% effectiveness rates for their patients, it may also be a fact that poking some needles virtually anywhere will get 40%-50%, sometimes even 60% effectiveness. (See sidebar.) If that is the case, then the value of comprehensive traditional training and years of experience may be in getting that extra 20-30% of successful outcomes.

I am not surprised that poking needles anywhere can help a decent percentage of pain-related cases because I believe any acupuncture stimulates the body to produce anti-trauma chemistry such as pain modifiers and anti-inflammatory compounds. That is why I was never strongly opposed to other health care professionals being able to legally do some acupuncture. I have long felt that rather than fighting to prevent other health care professionals from having the right to perform acupuncture, theOMprofession should be trying to educate these other professions that the more comprehensive training allows for that additional 20-30% effectiveness. In a spirit of mutual respect, we could encourage other health care professionals to refer their more difficult cases to us. This suggestion may not be welcomed by some, but theOMprofession must be open to evolve with the times.

Regardless of how we approach the issue of other health care professionals using acupuncture in their practices, the recent studies and media reporting of their findings should make one thing very clear: The OM profession needs to be much more proactive both in encouraging research that better reflects real-world acupuncture and in educating the public and media about OM and the OM profession. TheOMprofession has never mounted a comprehensive, multi-year, public education campaign. We have never seen fit to make such a campaign a priority. This must change. We cannot continue to leave the manner in whichOMis perceived by the public and portrayed within the media to outside forces. For too many years, our profession has acted as if all we have to do is raise education standards and do the good work of helping people and the rest would take care of itself. The conclusions of these studies and the media reports that followed should be making it clear that this is not the case.

Conclusion

If it were true that getting successful results does not depend on where one puts the needles, then every first-year acupuncture intern would get the same results as their most experienced teachers, which is not the case. While it seems to be true that having positive qi can make up for lack of experience, almost any acupuncturist will tell you that they get better results with experience. After training and licensure, acupuncturists typically spend the next several years of their careers learning more techniques and theories to add to their arsenal. Why do we do this? Because we learn that sometimes your Plan A or Plan B does not get results, so you better have a Plan C, D, and E as back-up if you want to get the highest degree of success. If it did not matter where you put the needles, no one would bother to keep learning additional techniques and the robust continuing education offerings out there would cease to exist.

We OM professionals, who work our tails off helping our patients, know how valuable our services are and we know that points do matter. We are buoyed by the gratitude of our patients, even as they tell us how they wished they had known aboutOMsooner and wonder why more people don’t take advantage of this safe healing resource. We don’t have to manipulate the facts to educate the public, media, and policymakers about what we have to offer, but we do have to guard against allowing the facts to be manipulated against us. There are acupuncture researchers who have a greater grasp of the subtle dynamics of clinical acupuncture, including the Society for Acupuncture Research, and the OM profession should do more to familiarize ourselves with their work and to encourage that the real-world effects of OM is given its just due.

References

  1. Haake M, Mueller HH, Schade-Brittinger C, et al. German acupuncture trials (GERAC) for chronic low back pain. Arch Intern Med. 2007;167(17):1892-1898.
  2. Cherkin D, Sherman K, Avins A, et al. A randomized trial comparing acupuncture, simulated acupuncture, and usual care for chronic low back pain. Arch Intern Med. 2009;169(9):858-866.
  3. Moffet HH. Sham acupuncture may be as efficacious as true acupuncture: A systematic review of clinical trials. J Altern Complement Med. 2009;15(3):213-6.
  4. Bankhead C. Acupuncture tops conventional therapy for low-back pain. MedPage Today, 2007. www.medpagetoday.com/PrimaryCare/AlternativeMedicine/6770. Accessed October 11, 2009.
  5. Doheny K. Acupuncture may ease chronic back pain. WebMD Health News, 2009.www.webmd.com/back-pain/news/20090511/acupuncture-may-ease-chronic-back-pain. Accessed October 11, 2009.
  6. Park A. Acupuncture for bad backs: Even sham therapy works. Time.Com, 2009.www.time.com/time/health/article/0,8599,1897636,00.html. Accessed October 11, 2009.
  7. Amaro J. Is most of acupuncture research a “sham?” Acupuncture Today. August 2009;10(8).www.acupuncturetoday.com/mpacms/at/article.php?id=32013. Accessed October 11, 2009.

About the Studies 

The two main trials referenced in this article are the German Acupuncture Trails (GERAC) for chronic low back pain and that carried out in both the Center for Health Studies,Seattle,Wash.and the Division of Research, Northern California Kaiser Permanente,Oakland,Calif.that is sometimes called the “Seattle Study.”

In the German trails, 1,162 patients were randomized into groups receiving “real” acupuncture, “sham” acupuncture, or conventional therapy. Participants underwent 10 30-minute sessions usually at 2 treatments a week for 5 weeks. An additional five treatments were offered to those who had partial response to treatment. The “real” acupuncture groups were needled at points traditionally believed to be beneficial for lower back pain while the sham acupuncture involved superficial needling at non-traditional points. At 6 months, positive response rate was 47.6% in the real acupuncture group, 44.2% in the sham acupuncture group, and 27.4% in the conventional therapy group.

In theSeattlestudy, 638 adults with uncomplicated low back pain of 3-12 months duration were randomized into four groups: individualized acupuncture, standardized acupuncture, simulated acupuncture, and conventional care. In the individualized acupuncture groups, a “diagnostic acupuncturist” considered the patient’s progress and prescribed points according to traditional theory. The prescribed points were then needled by the treating acupuncturist. The standardized group employed a set of points traditionally considered helpful in treating low back pain that were used throughout the treatment series. The simulated group had the same points as used in the standardized group but toothpicks were used to simulate the feeling of acupuncture. The treatments were done using back points so subjects could not see the needles. Treatments in the first three groups were done by experienced acupuncturists and consisted of two treatments a week for three weeks then once a week for four weeks.

At eight weeks, mean dysfunction scores for the first three groups were 4.5, 4.5, and 4.4 points compared to 2.1 points for conventional care. Symptoms improved by 1.6 to 1.9 points in the first three groups and 0.7 in the conventional care group.

While I emphasize the need to distinguish what both of these studies refer to as “real” acupuncture from that which is practiced in the real world of clinical acupuncture settings, the Seattle Study did make note that its design had limitations, including restricting treatment to a single component of TCM (needling), pre-specification of the number and duration of treatment, and limited communication between the patient and acupuncturist. While I applaud this study’s authors for mentioning these limitations, the conclusions they reached regarding the “strong and consistent evidence” that real acupuncture is not more effective than sham acupuncture indicate they did not consider these limitations too significant.


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