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A Long-Overdue Win for Oregon Medicaid Patients - and the Implications for Other States
Beginning July 1, 2016, Oregon Medicaid patients with spinal pain (cervical, thoracic, lumbar, pelvic) who are determined to be low risk based on a biopsychosocial assessment tool (STarT Back – Keele University) can receive four chiropractic visits per episode.
An MD Who Understands the Opioid Epidemic
Doctors of chiropractic have an important role to play in ending the opioid epidemic and dealing with chronic pain by conservative means (see our top story in this issue) – but who's to blame for opioid dependence and abuse in the first place?
Kansas Achieves Licensing Law
Kansas Governor Sam Brownback signed House Bill 2615 into law on Friday, May 13, 2016. HB2615 includes provisions for the licensure of acupuncturists in the state of Kansas.
Believe it or not, an estimated one-third of your patients have eaten some form of fast food within 24 hours of their appointment with you.
Tai Chi Documentary Premier
First Run Features recently announced the world theatrical premiere of Barry Strugatz's documentary The Professor: Tai Chi's Journey West, which premiered last month at the Laemmle Music Hall in Los Angeles.
Treating Hip & Groin Pain With Abdominal Release of Upper Lumbar Nerve Impingements
Have you encountered patients with groin and hip pain you can't seem to solve? You know it's not a worn-out hip; you suspect the pain is somehow connected to the spine. But somehow, you just can't help them break through.
Increasing the Value of Spine Care: CMS Approves New Low Back Pain Registry
The Centers for Medicare and Medicaid Services has approved the Spine IQ Low Back Pain Registry as a qualified clinical data registry for the Physician Quality Reporting System (PQRS) in 2016.
Chronic Pain: Become Part of the Solution
I have lectured to more than 7,000 chiropractic physicians over the past five years regarding the chronic pain and opioid epidemic in this country.
What You Say Isn't Always What Patients Hear
A few years ago, my aunt Edna (name changed for the purpose of this story) suffered a stroke. After a short hospital stay, she was transferred to a nursing home for rehabilitation. When she arrived at the nursing home, Edna requested a private room.
How to Stay Sane During the Elections: Understanding Through the Lens of Chinese Medicine
In Chinese Medicine philosophy, everything consists of Yin and Yang. The law of polar opposites – one cannot exist without its opposite.
Acupuncture's Impact on the World
For several years, I have been hearing about the town of Rothenburg, Germany. It seemed just a dot on a map until I arrived. It is the home of the TCM Kongress which began in 1968. It has been held annually for 47 years and it has only missed one year.
The Pertinent Negative
We all have to perform evaluations on patients. Most of us don't like doing it – exams take time, and worse it takes even more time after the evaluation to put together a narrative summary of the findings. Sometimes, this process becomes downright tedious.
Acupuncture Muscle Trigger Point and Oriental Medicine Sports Therapy
It is difficult to ascertain the internal condition of professional basketball player Lebron James during game one of the 2014 NBA finals, in which he developed debilitating muscle cramps that led to his premature removal from the game.
Beating the Odds: Interview With Para-Powerlifter Adeline Dumapong-Ancheta
Since October 2015, the FICS Foundation, the charitable organization affiliated with the International Federation of Sports Chiropractic (FICS), has been supporting disabled athletes internationally.
Introducing the Acupuncture Today Digital Edition
In response to the changing habits of our readers, Acupuncture Today will introduce a digital edition of the publication (in addition to our print edition) beginning with the August 2016 issue.
Insuring Quality Control in Herb Importation: An Interview with Wilson Lau
Wilson Lau is the vice president of Nuherbs, a Chinese herb importation company based in San Leandro, California. Before joining Nuherbs, he trained as a lawyer specializing in FDA law.
An Emerging Partnership Model
Maryland University of Integrative Health (MUIH) has educated integrative health and wellness practitioners for the last 40 years, originally as an acupuncture clinic and school. The institution's transformative, relationship-centered programs integrate traditional wisdom with contemporary science
AOM Hospital-Based Practice: A Future Reality?
The natural evolution of health care on the planet is integrative health. We may have some challenges ahead, but based on my research, all indicators are pointing in a positive direction. There seems to be an evolving consciousness among our patient population that is "getting it."
What's New in Phytonutrition: Mangifera Indica, "The King of Fruits"
One hundred percent pure Indian green mango fruit (mangifera indica), harvested at a special degree of ripeness for efficacy and taste, can now be concentrated as a phytonutrient nutraceutical powder.
Adventures with the San Jiao
Those of us who have been in practice for several decades relish the way meridians and points reveal new diagnostic clues and new insights. I love to encourage my students to see this as an adventure that goes way beyond the textbooks.
Three Tips to Help You Analyze the Acupuncture Case Studies of the NCCAOM Exam
Confirm the answer quickly by the elimination method. Case study:
After two treatments for back pain, a patient presents for a third
session complaining of rapid breathing and wheezing that is made worse
during cold weather.
Sit or Stand? Analyzing a Mixed Message
I'm more than a bit confused. At my age, that seems to be a rather common occurrence. However, today more than ever, I'm getting a mixed message.
February, 2001, Vol. 01, Issue 02
"Not Now, I Have a Headache!"
By Barbra Esher, AOBTA CI. Dipl. ABT & Ac. (NCCAOM), LAc
Sometimes Useful, but Not Inevitable
One of my instructors said that the most difficult part of treating a headache in China is figuring out whether the client has one or not.In China, it apparently is an accepted excuse for calling in sick to work, so many people show up at the clinic for a doctor's excuse.
In the U.S., it seems as if headaches are considered an inevitability of a stressful and busy life. An employer would not likely consider letting someone off work for a bodywork treatment! "Take some aspirin and get back to work!" would be a more likely response to an employee moaning about a headache.
When I interview clients and find they get headaches, they seem surprised when I ask detailed questions. "Can you help with THAT?" they ask, hardly daring to hope for relief. Luckily, it's fairly simple. By asking about the frequency, location, timing and quality of the pain, you can determine what is causing the imbalance and how to treat it. Accurate assessment of the problem is essential to get to the root cause.
You probably already know this, but it bears repeating. If a client comes to you in a state of disease you don't understand, refer, refer, refer! If a headache comes on suddenly, severely or is accompanied by nausea, tell the patient to use the acupressure point at the tip of the index finger to dial 911. I had a 41-year-old female client with those symptoms. She died in the parking lot in front of a hospital from a subarachnoid hemorrhage. Other causes of headaches that need medical intervention include meningitis, cerebral tumor, hypertension and ear infections. Be safe and get a medical diagnosis!
Looking at Patterns
In Chinese medicine, to reach an accurate assessment of a client's condition we need to look at the overall pattern based on the five elements and the zang-fu (the energetic actions of the organs); the quality of the pain; what makes it better and worse; and the location of the pain. I will give an example of each and delve more deeply into assessment by location, based on the meridians.
Five-element and zang-fu pattern discrimination look deeply at where the client is physically, emotionally and spiritually. These aspects have never been thought of as separate in Asia; they never suffered the Cartesian mind/body split as we did in the West.
When people have constipation, they are having trouble letting go of physical waste. This may manifest on an emotional level as well, in not being able to let go of waste in their lives. Maybe they are holding on to a lost love or friends that are obviously toxic to them. In Chinese medicine, these are all manifestations of a metal imbalance - encompassing the lung and large intestine meridians. So the treatment is the same, whether they are physically or mentally having trouble letting go of wastes. It's the same imbalance, which could result in headaches. There are approximately 17 different five-element/zang-fu types of headaches, so I obviously can't go into each one in this article.
The quality of the pain is going to give other information. For example, a dull ache indicates a deficiency condition. Slow, deep-but-gentle pressure with the intention to tonify is used to treat this condition. Sharp pain means there is an excess condition; quicker movements are used to disperse, going away from the head.
What makes the headache better or worse also gives useful information. For example, the person who says that their headache gets worse after they have sex has a kidney qi deficiency. If having sex relieves their headache, then it is most likely due to liver fire or liver qi stagnation.
Treating by Location
Determining the location of the headache is essential in developing a treatment plan in conjunction with zang-fu pattern discrimination. The four areas of the head (and corresponding headaches) are listed below:
Taiyang headaches are treated by working on the two taiyang meridians: the bladder and small intestine. It is important to work on local points, like GB 20, as well as distal points on the bladder and small intestine, like BL 60 and SI 3. All of these have a powerful affect on the neck and occiput region. A chronic headache in this region could be due to a kidney qi deficiency manifesting in the bladder meridian.
Temporal shaoyang headaches need gall bladder and triple heater meridian treatment. GB 8 and taiyang are useful local points. The distal points are on the shaoyang meridians - TH 5 and GB 41. I often teach GB 41 to clients with migraines. Someone once told me, "That's so funny! Whenever I have a headache, I'm intuitively drawn to pressing that area of my foot, and it helps!"
The location of this headache follows the course of the gall bladder meridian, which has a very close relationship with the liver. I can guarantee that the liver is somewhere behind the cause of that headache, whether it is liver-fire, liver-yang or liver-wind rising. Keep this in mind when you are doing a more detailed assessment.
Yangming frontal headaches require large intestine and stomach meridian balancing. A common mistake is to treat a headache in the forehead region with bladder meridian points, when in actuality, stomach and large intestine are much more effective. The stomach meridian internal pathway begins at LI 20, and as it goes up alongside the nose, reaches the forehead from BL 1.
Maybe the most famous acupressure point for headaches is LI 4, located on the webbing between the thumb and index finger. It is quite effective for headaches as a distal point, but only for yangming headaches! People that have tried this point with other types of headaches are most likely convinced this acupressure stuff is a bunch of hooey. Along with LI 4, use ST 44 as another distal point. Effective local points for this type of headache are St 8, yintang and ST 3. A yangming headache often is caused by dampness (tx SP 9) or phlegm (tx ST 40). Symptoms pointing to these pathogenic factors are a heavy, muddled feeling in the head, a sticky tongue coating and a rolling pulse. Brace yourself for a long haul, though, since these are the most difficult pathogenic factors to resolve!
Finally, jueyin headaches are at the top of the head. This is related to the liver meridian, which has an internal pathway up to that area. An effective local point is DU 20; an excellent distal point is LV 3. A jueyin headache could be due to deficient qi and blood as well. Best to look at all signs and symptoms.
The above examples are more useful for those who have gone through a complete program of Asian bodywork therapy. ABT is an ancient healing art that allows you access to a person's core being. You aren't going to get it by reading an article. Get out there and learn it! It's a whole new way of being in and relating to the world.
Click here for previous articles by Barbra Esher, AOBTA CI. Dipl. ABT & Ac. (NCCAOM), LAc.
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