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News Letter, Vol. 8 (2), March, 2017, © Copyright

Jun Xu, M.D., Hong Su, C.M.D., Lic. Acup. http://www.rmac.yourmd.comwww.drxuacupuncture.co

Rehabilitation Medicine and Acupuncture Center

1171 East Putnam Avenue, Building 1, 2nd Floor

Greenwich, CT 06878

Tel: (203) 637-7720

How Can Acupuncture treat Occipital Neuralgia?

后头痛

 

 

Linda, a 45-year-old female dental assistant, came to me complaining of severe headaches that started at the back of her head and continued down a portion of her neck.  The pain also radiated up to her scalp, around her ears and sometimes into the bilateral temporal area.  The pain was off-and-on, but occurred every day.  The pain ranged from dull to sharp, and was sometimes located directly behind the right eye.  As a dental assistant, she constantly turned her head to the right when dealing with patients.  This caused the headache to become more severe, and she was frustrated that it interfered with her daily work.  She had consulted several doctors about her condition, and had been prescribed Naprosyn, Percocet and Neurotin, but none of them alleviated her condition.

These headaches intensified when Linda was under stress, which was often because of her job: if she had many patients waiting for her and felt under pressure, the headaches worsened.

When I examined Linda, I discovered that when I pressed her scalp at the base of the skull and suboccipital area, the pain radiated to the back, front and side of her head, and also to the right side of the eye.  When I pressed hard on the suboccipital area (the base of the skull) the pain was exacerbated and I could feel the bilateral temporal artery palpating.

The patient probably suffers from occipital neuralgia, which is a cycle of pain spasms originating in the suboccipital area, caused by an inflammation of the occipital nerves.  The two pairs of occipital nerves (each nerve contains a greater and lesser occipital nerve) originate in the second and third vertebrae of the neck.  These nerves supply areas of the skin along the base of the skull and behind the ear, but are not always connected directly with the structures inside the skull. However, they do interconnect with other nerves outside the skull and continue into the neuro-network.  Eventually they can affect any given area along the scalp, mainly on the bilateral temporal area behind the ear and sometimes connect to the nerve branch on either side of both eyes.

Occipital neuralgia may occur continuously, often as the result of the nerve impingement, especially from arthritis, muscle spasm, or as the result of a prior injury or surgery.  Sometimes these conditions will impinge the occipital nerve root, leading to severe headaches at the back of the head, leading to muscle spasm.  Linda exhibits the severe form of occipitical neuralgia, most likely because her profession causes her to tilt her head in the same manner for a good part of her day. This stress causes the occipital nerve to be impinged, sending a constant signal to the nerve network in her scalp, leading to headaches and the pain behind her right eye.

The clinical diagnosis of this condition is based on palpation by the doctor of the bilateral occipital nerve root, which will induce or trigger the headache. Doctors currently use various treatments.  One option is to inject 1% lidocaine 5cc into the occipital nerve root, which decreases or relieves the pain, confirming the diagnosis.  A second option is to use surgery to cut or burn the nerve with a radial wave probe.  A third option is to use a small injection of Botox or a similar medication.  Western medicines include anti-inflammatory or narcotics such as Percocet or Darvocet, Naurontin, anti-epilepsy medication, etc.  For the majority, these medications do not work well, though occasionally they can reduce the occurrence and frequency of the occipital neuralgia.

Some patients respond to physical therapy and massages to decrease the spasm of the neck muscle, which might temporarily relieve the occipital neuralgia.  Though doctors may recommend surgery, many patients resist this type of treatment.

According to Traditional Chinese Medicine, occipital neuralgia belongs in the category of the side headache, i.e. the Shao Yang Gallbladder meridian headache.  Gallbladder meridians are distributed around the sides of the head, and excessive heat in the gallbladder can lead to headaches.  The gallbladder meridian originates from the outside of the eye, and continues up the temporal nerve area, around the lateral skull area, down the occipital nerve area, down through the trunk and to the outside of the leg.  If there is excessive heat along this meridian, there will be an imbalance of yin and yang.  For example, if the patient undergoes stress, muscle spasm or arthritis, the nerve and the gallbladder meridian will be impinged.  This, in turn, will cause the gallbladder to heat up, leading to excessive heat, an imbalance of yin and yang and a severe headache.

Another meridian identified in occipital neuralgia by Traditional Chinese Medicine is the urinary bladder meridian, which starts from the inside corner of the eye, continues through the middle and the top of the scalp, and follows down the back of the trunk and into the back of the leg.  Due to the connection between the gallbladder and urinary bladder meridians, heat in one will cause heat in the other to rise, generating pain around the eye, the temporal area and the scalp, and making the ensuing headache severe and highly unbearable.  Therefore, the principal acupuncture treatment is to relieve this excessive heat in the gall bladder and urinary tract.

穴位

表格

The main acupuncture points used for treatment are: Du 20 Bai Hui, GB 20 Feng Chi, GB1 Tong Zi Liao, GB 8 Shuai Gu, Extra point Tai Yang, GB 34 Yang Ling Quan, SI 3 Hou Xi, Lu 7 Lie Que, Kid 6  Zhao Hai, Li 3 Tai Chong.

Linda underwent my treatment three times a week for one month, resulting in immediate, short-term relief of her headaches.  However, the headaches continued to plague her because of her strenuous work.  In addition, her irregular menstrual cycle and hormonal changes led to more severe headaches.  Thus, I also treated her for hormonal changes by utilizing a Chinese herb Da Zhi Xiao Yao San.  The combination of acupuncture and herbal therapy seemed to be effective and, after about two months of treatment, Linda reported that her headaches occurred only infrequently and were very mild, and that she was satisfied with her treatments.

Usually, acupuncture, with or without the addition of herbal supplements, can alleviate the problems and pain associated with these headaches.  However, sometimes it is best to combine acupuncture with a nerve block (utilizing 4cc of 1% lidocaine plus 10 mg Kenalog mixed together) injected into both sides of the occipital nerve origin.  One month of this combined treatment should give the patient 95% relief from his/her symptoms.

Tips for acupuncturists:

  1. You should identify the location of the pain and tenderness, and treat the headache accordingly.  For example, the frontal headache belongs to the Yang Ming meridian; the temporal side headache belongs to the Shao Yang meridian; the top scalp headache belongs to the Jue Ying meridian.
  2. Always use Du 20 Bai Hui for all the different types of headaches. This is based on my personal experience over 20 years of practice.

Tips for patients:

  1. You should be very specific when describing the tender points on your head because each tender-point location belongs to a different meridian, and treatment varies based on each location.
  2. Massaging the Tai Yang and UB 20 Feng Chi points for 20 minutes, 2 to 3 times a day, will greatly decrease the headache.

 

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West Africa’s Calling for Dr. Jun Xu, Report one—His

team work in leprosy village of Senegal

Dr. Jun Xu went to Leprosy village in 2013, 2014 and 2016, soon he will go to the leprosy village on March 31, 2017.

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In 2013, there was no a single room being used for treatment in the leprosy village, Dr. Xu and his team had to use a tent. The temperature was around 125 Fahrenheit degrees.

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The leprosy patients were waiting for their turn to be attended. Dr. Jun Xu saw about 200 patients a day.

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Typical leprosy patient:

 Early Stages

Spots of hypopigmented skin- discolored spots which develop on the skin. Anaesthesia(loss of sensation) in hypthese opigmented spots can occur as well as hair loss.

“Skin lesions that do not heal within several weeks of and injury are a typical sign of leprosy.” (Sehgal 24)

Progression of disease

“Enlarged peripheral nerves, usually near joints, such as the wrist, elbow and knees.”(Sehgal 24)

Nerves in the body can be affected causing numbess and muscle paralysis

Claw hand- the curling of the fingers and thumb caused by muscle paralysis

Blinking reflex lost due to leprosy’s affect on one’s facial nerves; loss of blinking reflex can eventually lead to dryness, ulceration, and blindness

“Bacilli entering the mucous lining of the nose can lead to internal damage and scarring that, in time, causes the nose to collapse.”(Sehgal 27)

“Muscles get weaker, resulting in signs such as foot drop (the toe drags when the foot is lifted to take a step)”(Sehgal 27)

Long-term Effects

“If left untreated, leprosy can cause deformity, crippling, and blindness. Because the bacteria attack nerve ending, the terminal body parts (hands and feet) lose all sensations and cannot feel heat, touch, or pain, and can be easily injured…. Left unattended, these wounds can then get further infected and cause tissue damage.” (Sehgal 27)

As a result to the tissue damage, “fingers and toes can become shortened, as the cartilage is absorbed into the body…Contrary to popular belief, the disease does not cause body parts to ‘fall off’.” (Sehgal 27)

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Every year, Dr. Jun Xu and his team bring around $300,000 worth of medicine donated from his team members and Americares in Stamford, CT to treat the leprosy and other patients in Senegal and Guinea Bissau. http://www.americares.org/, in 2017, his team also received medicine donation from Direct Relief in California, https://www.directrelief.org/.

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Dr. Jun Xu and his team finally established a clinic in the leprosy village, one building for the clinic, and another building for the living of doctors and nurses.

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Leprosy village people were celebrating the opening of the clinic.

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There are 8 wards, which could hospitalize the patients if it is medically necessary.

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Dr. Jun Xu’s team usually stay in Senegal for 10 to 14 days every year, these are the foods his team brought from US in order to keep them health and safe. They do not dare to eat street food.

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The above are the coolants Dr. Jun Xu’s team to carry their food from US.

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Dr. Jun Xu and his team from US in 2006.

If you are interested in joining Dr. Jun Xu’s team or donating to his work in Senegal, please address your check payable to AGWV, and send to

Jun Xu, MD, 1171 E Putnam Avenue, Riverside, CT 06878, USA.

Dr. Xu promises that all your donation 100% will go to Senegal and his team will nerve use a penny from your donation. You will receive the tax deductible receipt. Any amount is a great help for Africa patients.

for more info, please visit our website:

http://www.drxuacupuncture.co and http://www.africacriesout.org

 

 

 

 

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News Letter, Vol. 2 (8), August, 2010, © Copyright

Jun Xu, M.D. Lic. Acup., Hong Su, C.M.D., Lic. Acup.

www.drxuacupuncture.com

Rehabilitation Medicine and Acupuncture Center

1171 East Putnam Avenue, Building 1, 2nd Floor

Greenwich, CT 06878

Tel: (203) 637-7720

Wrist Pain




Margaret D., a 45-year old pianist and professor at a music school in New York, had been preparing for a European concert for a year and was thus practicing more than usual.  A month before she was due to depart for Europe, she began experiencing a constant and severe pain in her left wrist. The pain, which was sharp, originated near the base of her thumb and gradually spread farther back into her forearm.  When she played the piano or tried to grasp or pinch an object, she felt a sharp pain in her wrist.  She also felt some numbness at the back of her thumb and index finger, and found a fluid-filled cyst on her left wrist.  Overall, she had difficulty moving that thumb and wrist.  She was extremely nervous and upset when she consulted me, fearing she might have to cancel her European concert.

Upon examining her, I found that her left wrist was swollen and extremely tender, especially at the base of the thumb.  Margaret was unable to bend her wrist or grasp a book or a cup.  Believing that she had de Quervain tenosynovitis, I performed the ‘Finkelstein test’ to determine the source of Margaret’s pain.  I asked her to hold her thumb in the palm of her hand and bend her wrist toward the little finger.  Margaret felt immediate exacerbation of the pain, which confirmed my diagnosis of de Quervain tenosynovitis.

De Quervain tenosynovitis affects two tendons: the extensor pollicis brevis and the abductor pollicis longus, which are located on the lateral side of the wrist.  These run parallel to each other and pass through the wrist in the synovial sheath.  This sheath enables the tendons to exercise their function: i.e. flexing and extending the thumb, like when you make a fist.

Some doctors believe the cause of de Quervain tenosynovitis is unknown.  Others believe that it can be caused by repetitive exercise such as playing piano, like in Margaret’s case.  Overuse of the two tendons can cause wrist pain, swelling, numbness or a tingling sensation when the nerve is pinched.  The differential diagnosis also includes osteoarthritis of the first scarpometacarpal joint: i.e. the osteoarthritis at the base of the thumb.

There are various ways of treating this condition:

  1. Western medicine:
    1. Non-steroid anti-inflammatory drugs such as ibuprofen, naproxen, Aleve, etc.
    2. Steroid injections, which are often extremely effective, however, the side effect is that steroid might cause the tendon become fragile and easily reinjuried.
    3. Natural treatment:
      1. Immobilization of the thumb by using a spica splint, which fixes the thumb in place, promotes total rest, and avoids any thumb movements. 2. Hot/cold compresses can be effective.  First apply a heating pad to the affected area to induce blood flow to the                  affected thumb and wrist, which will flush away the inflammatory factors.  Next, apply ice packs to drive away the                  inflammatory fluids.

2.Acupuncture.  The three most important points to utilize in this treatment are

  1. Large Intestine 4 He Gu, which serves to increase the endorphin secretion in the brain. It can thus synchronize with local points to decrease the pain signals from the brain.
  2. Large Intestine 5 Yang Xi and San Jiao 4 Yang Chi.  LI 5 is the point located exactly in-between the tendons of the extensor pollicis brevis and the abductor pollicis longus of the distal insertion.  SJ 4 is adjacent to the LI 5, and will help the healing effects of LI5. Heating this area will increase the amount of blood flow and wash away the inflammation.  Electrically stimulating the two needles will continually increase the energy flow to the area to decrease the feeling of pain.
  3. Large intestine 11 Qu Chi. LI 11 is the point along the same meridian of LI5 and helps decrease the pain by activating energy from the distal meridian.
Points Meridian/No. Location Function/Indication
1 He Gu LI 4 See table 3-1/Pic 3-4 See table 3-1
2 Yang Xi LI 5 On the radial side of the wrist, when the thumb is tilted upwards, it is in the depression between the tendons of m. extensor pollicis longus and brevis Headache, redness, pain and swelling of the eye, toothache, sore throat, pain of the wrist
3 Yang Chi SJ 4 On the transverse crease of the dorsum of wrist, in the depression lateral to the tendon of m. extensor digitiorum communis. See Pic 11-1. Pain in the arm, shoulder and wrist, malaria, deafness, thirst.
4 Qu Chi LI 11 See table 4-1/Pic 4-2 See table 4-1

Pic 8-3

Margaret received acupuncture treatment three times a week for four weeks then came in twice a week for an additional six visits with the electrical stimulation and heated needle treatments.  She also wore the spica splint and used an ice massage treatment immediately after practicing piano.  Her pain decreased significantly and she went to Europe for her piano tour.  As a reward to me, she brought her CDs recorded in her Europe trip to me. She had very successful performance.

Tips for acupuncturists:

  1. In addition to the above points, you may add a few Arshi points along the insertional tendons of extensor pollicis brevis and abductor pollicis longus. Note that the distal tendons are located in the lateral wrists, and are also called the “snuff box”.
  2. Recommend that the patient wear the spica splint, which will immobilize the patient’s wrist and accelerate the healing process.

Tips for patients:

  1. The sooner treatment is commenced, the better chance you have of recovering; you should not wait to consult the doctor.
  2. Resting and immobilization are necessary.  Many physicians think the cause of this condition is idiopathic (unknown), but my observation is that mechanical repetitions of the thumb cause this condition.
  3. After acupuncture and heating and electrical stimulation, it is best to apply ice to the wrist, which in turn helps decrease the inflammation.

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