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Cervical dystonia case

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Acupuncture For The Treatment Of Adductor Spasmodic Dysphonia
Steven Scheer, MD; Linda Lee, PhD

From http://www.medicalacupuncture.org/aama_marf/journal/vol14_3/article4.html

Vol. 14, #3

ABSTRACT
Background
     Spasmodic dysphonia (SD), a rare neurologic spasm of the vocal folds, results in a chronic voice disorder that can affect patients’ quality of life. Current treatment, including surgery and botulinum toxin injections, produces inconsistent results.
Objective     To investigate the use of acupuncture in the treatment of SD.
Design, Setting, and Participants   Prospective case series of 10 individuals (n=9 women; mean age, 45 years) with adductor SD in a metropolitan Ohio area during 2001.
Intervention     Eight sessions (1 week apart) of acupuncture using the LU-LI distinct meridian; during sessions 2-8, electrical stimulation was applied. Auricular acupuncture to “larynx” points during sessions 4-8
Main Outcome Measures     Self-report of participants’ perception of sound and ease of voice production, as well as changes in vocal quality observed by speech/language pathologists and subjects’ associates.
Results     There was no value in the LU-LI treatment without electrical stimulation. Seven of the 10 participants reported vocal improve-
ment, and 2 others noted improvement during specific times of the investigation. Seven rated satisfaction as 3 or higher on a 5-point scale. Seven individuals reported that others noted vocal improvement.
Conclusions   Most participants reported improvement in vocal quality and speech production following acupuncture treatment. Further research of acupuncture for SD is needed.
KEY WORDS
Spasmodic Dysphonia, Voice Disorder, Acupuncture, Overadduction, Overabduction

INTRODUCTION
he neurologic condition known as spasmodic dysphonia (SD) or uncontrolled spasm of the vocal folds results in a chronic voice disorder.1,2 Believed to be related to the focal dystonias that include blepharospasm, torticollis, and writer’s cramp, SD is defined as an extreme overadduction or overabduction of the vocal folds that interferes with phonatory vibration.3-6 SD does not respond well to conventional voice therapy, behavior modification, or oral antispasmodic medication.5

While SD is rare (current estimates are 1 case in 20,000 persons), for many individuals, it is extremely disabling in life and work.5 The range of onset is from 3 to 85 years, with a mean around 38 years. It occurs more often in women (58%) than in men (42%).6 There are adductor, abductor, and mixed types of the condition, and some patients have symptoms of other focal dystonias as well.6 In the most common form, the adductor type, voice production is characterized by strain and effort, pitch or voice breaks, and there are occasional complete blocks in the ability to sustain the vibratory cycle.7-9 Because of the hyperadduction of the vocal folds and the amount of effort needed to phonate during spasms, many patients complain of physical fatigue, tension in the muscles surrounding the neck, and shortness of breath. Some persons with SD develop fear of speaking that may interfere with holding a job or even maintaining relationships. Use of the telephone is especially difficult for others. Initial thoughts on the possible psychiatric origin of SD have since been discounted.3,4 The presumed central nervous system site of the pathophysiologic disturbance is in the basal ganglia; exactly where is unclear, as is the case with other focal dystonias.10,11

Until recently, persons with this development were forced to resort to either surgical resection of the recurrent laryngeal nerve or the laryngeal muscles, or to the injection of botulinum toxin into one or, rarely, both vocal folds.2,12 Dedo and Izdebski2 established a surgical approach involving unilateral resection of the recurrent laryngeal nerve. While the initial success was reportedly high, subsequent reports suggested that the return of vocal cord dystonia and a worsened vocal quality were as high as 60% in the 3-year follow-up period.12

Another surgical approach, laryngoplasty, caused vocal cord relaxation but with a potential sacrificed loss of pitch and loudness.12 A newer procedure developed by Berke et al12  that prevents reinnervation of the vocal cord adductor muscles appears promising, but is still being investigated.

Use of botulinum toxin was approved by the US Food and Drug Administration (FDA) in 1989 for treatment of blepharospasm (eyelid spasm).7-9 The toxin blocks the release of acetylcholine at nerve terminals. If directed to localized areas of innervated muscle, botulinum toxin can be an effective local paralyzer of unneeded muscle action.

Shortly after its FDA approval for blepharospasm, botulinum toxin was used off-label for the treatment of SD.7 Following injection, the paretic muscle loses its spasm, but the vocal quality after treatment is quite variable: some patients have only a whisper for a number of weeks after injection while others have only a brief remission from the spasm and a return of the entirety of vocal problems within a few months.8,12,13

The procedure is expensive ($500-$750 per injection) and must be repeated every 2-12 months indefinitely.8,12,14 Each injection is followed by occasional difficulty in swallowing.8,12 Over time, botulinum toxin may lose its effectiveness, perhaps due to calcification of the injected muscle.14 Unofficial estimates of the frequency with which botulinum toxin injection is used for disabling SD are approximately 75% of patients with the condition.

A group of academic speech/language pathologists at the University of Cincinnati learned of a limited case study on the use of acupuncture for SD in 1997.15 The patient who underwent acupuncture therapy for SD improved on all measures of voice parameters even after a 6-month follow-up period. The exact nature of the acupuncture treatment was not identified in the report and an attempt to reach the investigative team was unsuccessful.

The first author participated as one of two physician acupuncturists in a pilot study of individuals with adductor SD in metropolitan Ohio. We intended to identify, using a few types of acupuncture treatments, whether a combination of methods could improve acoustic measures of voice and perception of vocal quality. We also hoped to determine which of a battery of measurement procedures best described the effects of treatment.

METHODS
Patient Selection
Ten individuals with adductor SD were investigated during 2001. The participants were drawn from the files of local speech/language pathologists or were recruited through an advertisement in the local SD newsletter. Participants ranged in age from 31 to 70 years (mean 45 years). Nine of the participants were women.

Five individuals had never received botulinum toxin injections, either because they were newly diagnosed or because they had rejected its use. Of the remaining 5 who had received botulinum toxin in the past, we excluded from consideration any persons who been treated within 12 months of the 1st acupuncture session. None of the 10 had undergone surgical treatment for SD. All eligible individuals gave informed consent to participate. The research proposal was reviewed and approved by the institutional review board of the University of Cincinnati.

Speech Evaluation
All clinical testing of speech variables was performed independently by 3 licensed speech/language pathologists from the University of Cincinnati or Miami University of Ohio. Main outcomes included measures of voice analysis (Kay Elemetrics Motor Speech Profile, CSL Model 4300B, Lincoln Park, NJ), and a self-report of participants’ perception of sound and ease of voice production (Voice Handicap Index16). Additional perceptual voice analysis was performed after participants were tape-recorded while reading a standard passage. After the treatments were completed, participants were asked a series of open-ended questions regarding their experience with the protocol, changes in vocal quality noticed by themselves, coworkers, or family members, and future plans regarding acupuncture. Participating physicians did not collect any data so as to minimize observation biases.

Acupuncture Treatment
 The acupuncture protocol (Table 1) was devised by two treating physicians, with input from Dr Joseph Helms and reference to primary texts.17,18 Each participant received 8 treatment sessions, spaced about 1 week apart. For each treatment, participants were placed on a padded plinth in the supine position. Music was played for added relaxation. Session 1 began with a brief description of the procedure to allay anxiety about acupuncture.

In each of the 8 sessions, the protocol required use of the LU-LI meridian17 (Figure 1) plus a focusing point at ST 9, electrically stimulated for all but the 1st session: LU 1 and LI 15 (crossed for negative black clip), LI 18 and ST 9 (crossed for positive red clip). Needles at ST 9
(Figure 1) were directed inward toward the middle of the thyroid cartilage lamina. Stainless steel Seirin 40- and 6-mm needles were used for the LU-LI meridian approaches. During sessions 2-8, a 3-channel electrical stimulator (OMS Medical Supplies Inc, Braintree, Mass) was used at either 80 Hz or 15 Hz. The needles were left in place for approximately 30 minutes. For body tonification points electrically stimulated during the 8th session, 2.5 Hz frequency was chosen. During sessions 2 through 8, attempts were twice made to turn up the intensity of electrical stimulation during each session to enhance the effect.

Ear acupuncture, used initially in session 4, featured double needling of both the French and Chinese “larynx point,” located respectively on the medial surface of the tragus and just posterior to the external auditory meatus on the cavum conchae19 (Figure 2). For ear acupuncture and for the needling of Ting points (LI 1 on the index finger tip, ST 45 on 2nd toe tip), 15-mm plastic-handled Seirin needles were used. Ear tacks 1.5 mm long were placed on the 2 larynx points of both ears for 5 days after session 6.

All participants received exactly the same acupuncture treatment protocol in sessions 1 through 3. Beginning with session 4, the acupuncturists allowed each patient to provide some input as to the efficacy of the previous 2 sessions. For sessions 4-8, the use of either 15 Hz or 80 Hz stimulation frequency was determined by the participants’ individual input as to which of treatments 2 or 3 provided the better week-long improvement. In sessions 7 and 8, participants could choose between use of Ting points (from session 6) or body tonification points (from session 5), again according to their self-perception of improvement.

 Table 1. Acupuncture Protocol by Session

Session

Protocol

1

LU-LI distinct meridian, needles in dispersion, for 30 minutes

2

No. 1 plus electrical stimulation, 80 Hz for 30 minutes

3

No. 1 plus electrical stimulation, 15 Hz for 30 minutes

4

No. 2 or 3 plus double needling of both “larynx points” in each ear, 60 minutes

5

No. 2 or 3 plus body tonification points (LI 4, ST 36, SP 6, LV 3, MH 6) for 20 minutes

6

No. 2 or 3 plus double needling of LI and ST Ting points for 20 minutes; ear tacks placed on bilateral larynx points for 5 days

7

No. 2 or 3 plus choice of Ting or tonification points from sessions 5 or 6

8

No. 2 or 3 plus choice of Ting points or electrical stimulation of LI 4 and SP 6 at 2.5 Hz plus needles in other tonification points: ST 36, ST 43, PC 6, HT 3, LV 3

RESULTS
Participants showed significant improvement in some measures of vocal production and movement from outside to within normal range following treatment for many variables, even when statistically significant differences were not observed. Additionally, patients reported statistically significant improvements in their daily voice use on the Voice Handicap Index.

There was no value in use of the LU-LI Distinct Meridian treatment without electrical stimulation. Some participants were generally satisfied with the use of the Distinct Meridian; however, that was after at least 2 sessions that included electrical stimulation. Participants were equally likely to choose the 15-Hz or 80-Hz frequency setting for sessions 4-8.

Participants disliked the use of Ting points and did not feel they represented added value to the treatment; neither was there positive consensus about use of the body tonification points. Beginning with session 4, some individuals experienced reduction in vocal fold spasms with auricular stimulation at the French and Chinese “larynx” points. By the end of the study, the greatest improvements were noted when electrical stimulation was added to the Distinct Meridian treatment (session 2), and when the ear larynx points were stimulated (sessions 4 and 6). However, objective measures of voice production were more inconsistent in showing a positive response within 10 days after the protocol was completed.

Figure 1. Diagram of the Lung-Large Intestine Distinct Meridian Acupuncture Points
Point 1 (LI 18) is located on the middle belly of the sternocleidomastoid muscle, lateral to point 2. Point 2 (ST 9, slightly displaced) is located at the anterior border of the sternocleidomastoid at the level of the thyroid cartilage. Point 3 (LI 15) is on the upper deltoid, just in front of the acromion. Point 4 (LU 1) is 2 in below the acromial end of the clavicle, in the depression. For electrical stimulation during sessions 2-8, needles at 3 and 4 were crossed and clipped by the negative pole stimulator (black); needles at 1 and 2 were crossed and clipped by the positive pole stimulator.

 

On a post-treatment questionnaire, 7 of 10 participants reported improvement in their voices, and 2 others noted improvement during specific times in the protocol. Seven of 10 individuals rated their satisfaction with treatment for voice quality as a 3 or higher on a 5-point scale. Six rated as 3 or higher their feelings about amount of voice change. Seven stated that family members and friends noticed improvement, and 3 of the 7 who were employed said coworkers noticed improvement.

DISCUSSION
With its significant life effects, persons with SD are frequently desperate to receive treatment for their voice disorder. 20,21 Surgery on the vocal mechanism that will yield consistently good outcomes for persons with SD is still being investigated.12 The usual treatment available in larger medical centers, and sought by patients who must sometimes travel long distances to receive it, is botulinum toxin injections repeated every 2-12 months.7-9,12,13 An available alternative to botulinum toxin injections or a treatment that would extend the period between injections would be well received.

Therefore, we were hopeful to find which of several types of acupuncture could benefit persons with SD. We were aware of only 1 other published account of the use of acupuncture for a single patient with SD.15 The points used and treatment protocol were not identified in that study.

Our decision to use the LU-LI meridian was based on its trajectory and territory of influence that incorporates the trachea,vocal cords, and larynx.17 Use of the focusing point at ST 9 (Figure 1)
is an obvious choice for all laryngeal disorders. Use of ear acupuncture seemed reasonable because muscle sites represented on the ventral surface of the ear will readily relax with stimulation. The larynx points on the ear were commonly quite tender to touch and to needling, as typically occurs in auriculotherapy, in which a pathologic body part can appear to be “hot” in its corresponding ear representation.19 One of our consulting experts recommended use of the Ting points, but a limited trial at session 6 was not well received by our participants for subsequent sessions. Ting points are generally more useful for surface-level problems.19

Figure 2. Ear Acupuncture Points
C indicates Chinese “larynx” point inside tragus; F, French “larynx” point posterior to external auditory meatus.

We chose to use a standard protocol for each individual, allowing only a limited variation determined by participants’ input for the choice of frequency stimulation rate in the LU-LI meridian, and a variation on sessions 7 and 8 depending on the individual’s perception of better effects between sessions 5 and 6. Overall, each individual received generally the same treatment.

Individuals with previous botulinum toxin injections were allowed to participate because we believed that to have a sufficient sample size for our pilot study and for any future research on the use of acupuncture in SD, there was and will be a need to include individuals who have already had these injections.

Some participants reported week-to-week variation in the extent of improvement. The most dramatic and rapid laryngeal response to acupuncture was derived from bilateral needling of the larynx points on the inner surface of the tragus (Chinese larynx point), and the point 3 mm posterior to the external auditory meatus on the cavum conchae (French larynx point). One individual was speaking just as the ear larynx point was needled, and both he and the physician noted a dramatic change in vocal quality as the needle entered the point. The effect on that occasion lasted several days though the needle was removed after 60 minutes. Because of their awareness of the success of ear stimulation, some of our participants continued to use either a “pointer plus” 10-Hz ear point stimulator or a specially developed ear stimulator (provided by Dr Onje Erfan of Denver, Colo) that delivers electrical stimulation of several frequencies simultaneously. One month following the study, 5 of the individuals were self-stimulating the ear for their perceived improvements. At least 1 individual was still using ear stimulation bi-weekly 1 year later.

When asked to characterize their feelings about the effects of acupuncture in open-ended questions, a majority of study participants and frequently, their family members or coworkers, were positive. When asked to characterize the improvements, participants commonly described a reduction in the effort required to speak, and in perceived laryngeal tension while speaking. They commented that their voices, though still not normal, were more “functional” and could be “counted on.”

Future studies of the use of acupuncture for SD should consider scalp acupuncture and Koryo Hand acupuncture. There may be additional acupuncture programs derived from a Traditional Chinese Medicine (TCM) protocol that can be found through a Chinese literature search. A crossover design that uses different acupuncture methods would be beneficial, but a larger population will be needed to show significant differences. Finally, a trial that randomizes SD patients into either botulinum toxin injections or acupuncture treatment would be reasonable.

CONCLUSION
We undertook a pilot study to ascertain whether any of several standardized acupuncture treatments could ameliorate the vocal fold spasm and improve voice quality in persons with adductor SD. We found that a majority of our participants obtained subjective benefits in the ease of producing spontaneous speech through acupuncture treatment. The most useful approach included electrical stimulation with the LU-LI Distinct Meridian and auricular acupuncture on the larynx points. Further investigation of acupuncture for the treatment of adductor SD is warranted.

ACKNOWLEDGEMENTS
We sincerely thank Samantha Daughton, MA, Joseph Stemple, PhD, Barbara Weinrich, PhD, Tracy Miller-Seiler, MA, and Scott Goeller, MD, for their help in conducting this investigation. We also thank Susan Schmidt, PhD, and Aviva Scheer, PhD, for their editorial comments, and John Barrord, MD, for graphics work.

REFERENCES

  1. Frontis E. Results of a National Survey. National Spasmodic Dysphonia Association, reported by the Center for Voice Disorders of Wake Forest University; June 6, 1992.
  2. Dedo HH, Izdebski K. Intermediate results of 306 recurrent laryngeal nerve sections for spastic dysphonia. Laryngoscope. 1983;93:9-16.
  3. Aronson AE, Hartman DE. Adductor spastic dysphonia as a sign of essential (voice) tremor. J Speech Hear Disord. 1981;46:52-58.
  4. .Parnes SM, Lavorato AS, Myers EN. Study of spastic dysphonia using videofiberoptic laryngoscopy. Ann Otol Rhinol Laryngol. 1978;87:322-326.
  5. Colton RH, Casper JK, Hirano M. Understanding Voice Problems: A Physiological Perspective for Diagnosis and Treatment. Baltimore, Md: Lippincott
    Williams & Wilkins; 1996.
  6. Koufman JA, Blalock PD. Classification of laryngeal dystonias. Center for Voice Disorders of Wake Forest University Web site. Link: http://www.thevoicecenter.org/class_ld.html. Verified January 23, 2003.
  7. Blitzer A, Brin MF, Fahn S, Lovelace RE. Localized injections of botulinum toxin for the treatment of focal laryngeal dystonia (spastic dysphonia). Laryngoscope. 1988;98:193-197.
  8. Ludlow CL. Treatment of speech and voice disorders with botulinum toxin. JAMA. 1990;264:2671-2675.
  9. Zwirner P, Murry T, Swenson M, Woodson GE. Acoustic changes in spasmodic dysphonia after botulinum toxin injection. J Voice. 1991;5:78-84.
  10. Cannito MP. Neurobiological interpretation of spasmodic dysphonia.
    In: Vogel D, Cannito MP, eds. Treating Disordered Speech Motor Control.
    Austin, Tex: ProEd; 1990:275-317.
  11. Schaefer SD, Finitzo-Geiber TJ, Freeman FJ. Brainstem conduction ab-
    normalities in spasmodic dysphonia. In: Bless DM, Abbs J, eds. Vocal Fold Physiology. San Diego, Calif: College-Hill Press; 1987:393-404.
  12. Berke GS, Blackwell KE, Gerratt BR, Verneil A, Jackson KS, Sercarz JA.
    Selective laryngeal adductor denervation-reinnervation: a new surgical
    treatment for adductor spasmodic dysphonia. Ann Otol Rhinol Laryngol. 1999;108:227-231.
  13. Ford CN, Bless DM, Patel NY. Botulinum toxin treatment of spasmodic
    dysphonia techniques: indications, efficacy. J Voice. 1992;6:370-376.
  14. Lee RE, Tartell PB, Karmody CS, Hunter DD. Association of adhesive macromolecules with terminal sprouts at the neuromuscular junction after botulinum treatment. Otolaryngol Head Neck Surg. 1999;120:255-261.
  15. Crevier-Buchman L, Laccourreye O, Papon JF, Nurit D, Brasnu D. Adductor spasmodic dysphonia: case reports with acoustic analysis following
    botulinum toxin injection and acupuncture. J Voice. 1997;11:232-237.
  16. Jacobson BH, Johnson A, Gryswalski C, et al. The Voice Handicap Index (VHI): development and validation. Am J Speech Language Pathol. 1997;6:
    66-76.
  17. Helms J. The distinct meridian subsystems. In: Acupuncture Energetics: A
    Clinical Approach for Physicians. Berkeley, Calif: Medical Acupuncture Publishers; 1995:189-214.
  18. Unschuld PU. Introductory Readings in Ancient Chinese Medicine. Dordrecht, the Netherlands: Kluwer Academic Publishers; 1988:59-63, 69-70.
  19. Oleson T. Auriculotherapy Manual: Chinese and Western Systems of Ear Acupuncture. Los Angeles, Calif: Health Care Alternative; 1990.
  20. Lundy DS, Lu FL, Casiano RR, Xue JW. The effect of patient factors on response outcomes to Botox treatment of spasmodic dysphonia. J Voice. 1998;12:460-466.
  21. Benninger MS, Ahuja AS, Gardner G, Grywalski C. Assessing outcomes
    for dysphonic patients. J Voice. 1998;12:540-550.

AUTHORS’ INFORMATION
Dr Steven Scheer’s specialties are Physical Medicine and Rehabilitation, Sleep Medicine, and Medical Acupuncture.

Steven Scheer, MD*
St Luke Hospitals
85 No Grand Ave
Fort Thomas, KY 41075

Linda Lee, PhD, is Professor and Graduate Program Director in the Department of Communication Sciences and Disorders at University of Cincinnati, Cincinnati, Ohio. She teaches and conducts research in the areas of voice disorders, craniofacial anomalies, and respiratory disorders.
Linda Lee, PhD
University of Cincinnati
Dept of Communication Sciences and Disorders
202 Goodman Ave
Cincinnati, OH 45267-0379
E-mail: Linda.lee@uc.edu

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Here I post a doctor’s suggestion to his patient. I feel he is correct.
“I was just thinking why you may not have
taken advantage of your consultation.

You’re probably like many others who
suffer from back pain, headache, neck pain,
soreness, or any type of physical ache or pain…
the pain comes and goes and now you’re feeling
pretty good…am I right?

Sometimes even our patients often feel
better after the first few treatments,
and although this may seem good, the opposite
can sometimes be true as well.

Patients often mistake this feeling for a total
cure of their condition. They simply do not
realize that a relief of the symptoms DOES
NOT indicate a correction of the condition.

The smart patients never discontinue treatment
before their actual complaint has been corrected,
and if they do so, further complications are
bound to develop.

Even if you feel better, get checked out.

Prevent future problems.

We’ll extend our offer for a consultation,
but you have to call our office .
We’re standing by to hear from you and hopefully
help you prevent future problems.”

My phone number: 703-499-4428;

website: www.ChineseMedicineDoctor.US

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Last Sunday I had a lecture for alumni Association of Chinese Medicine in Washington DC. The topic is Liu Wei Di Huang Wan 六味地黄丸.

Here is my Power Point file.六味地黄

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I find a website which reports me using my several videos.

http://wn.com/DrArthurFan

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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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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,                   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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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: Arch Phys Med Rehabil. 2005 Apr;86(4):830-3.

Treatment of cervical dystonia and focal hand dystonia by high cervical continuously infused intrathecal baclofen: a report of 2 cases.

Dykstra DD, Mendez A, Chappuis D, Baxter T, DesLauriers L, Stuckey M.

Department of Physical Medicine and Rehabilitation, University of Minnesota, Minneapolis 55455, USA. dykst001@umn.edu

We describe 2 patients, one with cervical dystonia (CD) combined with focal hand dystonia (writer’s cramp) and another with idiopathic CD, who were unresponsive to oral medications and became resistant to botulinum toxin type A and B injections. Both patients were successfully treated with high cervical (C1-3) continuously infused intrathecal baclofen (ITB). Neck range of motion (ROM) was measured by using a 3-dimensional electromagnetic cervical ROM system. Pain, disability, and severity were assessed by using the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS). The patient with CD and writer’s cramp did well on a continuous baclofen dose of 186.1 microg/d. Her total TWSTRS score improved significantly, her electromagnetic measurements showed an increased in total neck flexion and extension, and her handwriting improved. Unfortunately, this patient (a heavy smoker) developed small cell carcinoma of the lung and died 9 months after her pump was placed. Total TWSTRS score and electromagnetic measurements also significantly improved after pump implant in the patient with CD. He continues to do well on a periodic bolus dose using a combination of 50 microg of baclofen and 25 microg of hydromorphone (Dilaudid) every 4 hours. Our findings suggest the potential usefulness of this therapy in other patients with focal dystonia. To our knowledge, this is the first reported successful treatment of CD and CD combined with writer’s cramp with high cervical continuously infused ITB.

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NFL Cheerleader Suffers Irreversible Dystonia after Flu Shot http://www.huliq.com/8059/87650/nfl-cheerleader-suffers-irreversible-dystonia-after-flu-shot

NFL cheerleader, Desiree Jennings, now suffers from a neurological condition brought on by the flu. See related story HERE.

DisabledTHIS YEARS FLU SHOT 10 days AFTER vaccination (Vedio) http://www.youtube.com/watch?v=Suo3Zk6GnXg&feature=player_embedded

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One herbal medicine (capsule) for dystonia(generalized dystonia, cervical dystonia/Spasmodic Torticollis, Meige’s syndrome, etc)  and related neurological conditions, has been approved by China Local FDA agency. It is priced at $50 per bottle (100 capsule). The dosage is 3 capsules each time, 3 times a day (a total of 9 capsules a day). Three bottles will last for a month, which makes the monthly total $150. 

For individualized herbal “tea”(decoction) based on Pattern Differentiation Technique (the information of tongue and pulse diagnosis, as well as bowl movement, etc will be used) the cost is $85 per week.  One treatment course is four weeks ($340; includes evaluation and prescription costs).

Basically, $490 is the price for one treatment course.

How long until the patient sees improvement?

Generally 2 weeks are need– around 80% patients see improvement by then.

If your cannot come, we can consider mailing the herbs to you. You can pay related mailing fee (depending on your mail handler) and handling fee($10).

We waive the cost $150 for evaluation, we help you to save some money.

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 Regarding to Long Distance Dystonia Issue Consultation

Acupuncture; Chinese herbal tea (individualized herbal decoction, capsule, etc)

TCM evaluation:Pattern differentiation

[Patient e-mail] 

Dear Dr. Fan

I saw on your website that you work on neurological disorders and chronic pain like dystonia.

My brother lives in S.D.. He has been suffering from Spasmodic Torticollis (ST) or Cervical Dystonia for the last 2 years. He has been to an acupuncturist and has gone through a lot of different treatments. None of them have helped.

As your website says, it is important to go to a very specialized person who knows acupuncture as well as neurology. We will appreciate it if you can identify and recommend such a person in S. D. so my brother can get treated.

 I appreciate your help in this regard.

 With regards,

A. D.

Details of his condition:  He was diagnosed with Spasmodic Torticollis in August 2007; He has done physical therapy and taken Botox injections in the past but they do not seem to work.

His current symtoms are:

(1) Pain in neck and shoulder; (2) Tightness/spasm in muscles; (3) Rotation/tilting of head; (4) Restricted movement of neck.

[Dr.Fan’s Reply e-mail]:

Subject:  Chinese Herbs for ST,  Treatment of Spasmodic Torticollis / Cervical Dystonia

Dear Mr.  A,

I do not know any acupuncturist very well in your area, who knows dystonia and had Chinese medicine training in that sope. You could let your brother to see a Chinese medicine doctor (CMD) /acupuncturist and collect basic information, such as tongue, pulse diagosis, etc.

In Traditional Chinese Medicine(TCM), the herbology is the main therapy and acupuncture and others are adjuvant to that. However, in US and most of western countries, acupuncture seems the first choice in TCM, due to it is easy to understand.  Herbology needs more trainning.

Individulized herbal tea, which containe 10 or more herbs and patient drinks the decoction(juice, after cooking), is the main part in Chinese herbology, the capsule, pills, tablets, etc are next it. But doing this needs more patient’s information, such as pulse, tongue and appetite, bowl movement, etc.

 He may see the effects in two weeks, basically, the spasm less.

 Arthur Yin Fan, PhD,CMD,LAc

[Patient e-mail in black color, Dr.Fan’s reply in red color]:

Dear Dr. Fan,

My brother is considering starting your treatment. He has a few questions about the information you asked for:

(1) For pulse, I guess it is easy: give you the pulses per minute(Dr.Fan replies: not so easy as you thought, please see a CMD or an acupuncturist who know how to take pulse.)

(2) For tongue: what specific information should he send(pls see a CMD or an acupuncturist who know how to see the tongue information.)

(3) For appetite: should he say whether he has large, normal or low appetite. Please let us know if you are looking for something else.(yes, how about the stomach condition?)

(4) For bowel movement: Do you want to know if he has constipation and the number of times he passes stool? (loss or constipated?) 

Also, he just started taking some Indian herbs a few weeks ago(Effective or not?). Please let me know if your treatment will be affected by any other herbs he is taking.

Thank you very much.

With regards,

A.D.

[Patient e-mail]:

Dear Dr. Fan,

 My brother saw an acupuncturist and got the following information:

————————————

Regarding Tongue and pulse…. 

Mr. PD has come to my office regarding his chronic neck pain and spasms. Today he arrived after having taken 5 mg. valium one hour before my examination of his pulse and tongue. 

His pulse rate was normal at the  time. There was a sense of excess, slightly bounding quality to the heart position in the upper jiao on the left wrist and a slight superficial, thin quality to the triple heater position on the right wrist. The kidney position was deep and deficient on the left wrist. His tongue was notably red and without coat on the anterior one third with a thin, white coat down the center and throughout the back area. The tongue body was normal in size but pointed on the tip. All signs indicated heat in the upper jiao. His poor sleep and worry also indicate heat in the heart/heart Yin deficiency. 

Appetite: Normal, stomach condition: normal 

Bowel Movement: Mostly regular once per day in the morning. Stool not very soft not very hard.

————————————– 

He would like to start your treatment as soon as possible. You had indicated the costs earlier for herbs and special tea.  

With regards,

AD

[Patient e-mail in black color, Dr.Fan’s reply in red color]:

Dear Dr. Fan,

Thank you for the clarification. My brother wants to do the more effective individualized tea you mentioned. 

You had mentioned that with the individualized tea and capsules he should see effects in 2 weeks, like the reduction in spasms from ST.  We are hoping that this will happen, and so are keen to get your individualized medicine for better impact.  The reason we searched for you and contacted you is because you were the only Chinese medicine doctor who mentioned Spasmodic Torticollis specifically and you mentioned success in treating the condition. We trust that your “decoction” will help my brother. [I am the right person who had training in both TCM and neurology, esp. treated many patients like your brother.   I sincerely hope the treatment will work well.  But for some patients, it may take time.  I only could say, our treatment might be better than others, esp. for those have no experience.  The effectiveness depends on many conditions, not everyone have same effectiveness–someone may have no effectiveness at all, esp.those have a try for one or two weeks–we need work hard to see the effects.] 

Also, I want to mention and get your comments about: 

(1) My brother may have to take Botox because he is obligated to consult a western medicine doctor and follow his advise. He will try to avoid Botox but cannot refuse treatment if the doctor insists. Is that OK and will it interfere with your treatment.[he could continue to use Botox, but he may reduce it if he see our treatment results–at least, herbal tea,or capsule/pills have no conflict to Botox: herbal tea and capsule work internally, adjusting our central nervous system, Botox only works on local muscle, which cause muscle slight paralysis, no longer spam during 3-4 months]

(2) As I mentioned earlier, he is taking some Indian herbs. He is seeing some positive effects of that and he wants to continue that along with your treatment. Will that be OK in your opinion? [I don’t know if it is ok or not. I have no information and training in india herbology]

(3) Please send detailed instructions about how to take your medicine. [Yes,you could see the instruction in our blogs, in Chinese Medicine ABC part]

(a) Directions for cooking herbs/tea [ see above comment]

(b) Time of the day for having the capsule and the tea [morning and afternoon, 2-3 times, after meal or with a little bit food]

(c) Should they be had before or after food

(d) Should the capsule and the tea be had together [no matter when, we evaluate the result after a while]

(e) Any restrictions on diet when under your treatment, any food to avoid etc

(f) Any other instructions you want to send

[no spicy food, avoid any food affected his stomach or intestine; avoid too much stress, keep a regular sleeping schedule]

[If have gas in stomach, add 2 pieces of fresh Ginger with the herbs during cooking.]

With regards,

AD

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