J. Acupunct. Tuina. Sci. 2010, 8 (1): 58-61 DOI: 10.

1007/s11726-010-0058-z

Case Report

Four Proven Cases by Acupuncture

ZHU Yi () Shanghai Research Institute of Acupuncture and Meridian, Shanghai 200030, P. R. China

Key WordsAcupuncture-moxibustion Therapy; Fatigue Syndrome, Chronic; Arthritis, Rheumatoid; Colitis, Ulcerative; Medical Records CLC NumberR246.1 Document CodeB In late November 2006, I was honored to participate in the Advanced Class on the Inheritance of Shanghai Senior TCM Doctors Academic Experience, and studied under Professor CHEN Han-ping for 3 years. Now I introduced some of my clinical experience on acupuncture as follows. Ashi points, Shenshu (BL 23), Pishu (BL 20), Ganshu (BL 18), Xinshu (BL 15), Zusanli (ST 36), Sanyinjiao (SP 6), Taichong (LR 3), Neiguan (PC 6), Yintang (Ex-HN 3) and Guanyuan (CV 4) were punctured with filiform needles, which were retained for 40 min. The neck and upper back were irradiated by TDP and then cupped on the Governor Vessel and Bladder Meridian for 5 min after needling. This treatment was performed 2-3 times a week. After a one-week treatment, the clinical symptoms were improved; and another 3-month treatment later, the clinical symptoms disappeared. After all the treatments, he was told to perform moxibustion on Zusanli (ST 36) and Guanyuan (CV 4) with a moxa stick by himself 2-3 times a week, for 15 min each time. Note: Some researches have revealed that great stress may affect endocrine and immune systems, causing dysfunctional hormones and a compromised immunity[1]. This patient suffered intense work stress with physical examination showing no organic diseases; but fatigue, irregular emotions and bad sleep lowered his quality of life. Fengchi (GB 20), Fengfu (GV 16) and Tianzhu (BL 10) were used to disperse wind and unblock collaterals; Jingbailao (Ex-HN 15) was combined to promote the flow of meridian qi in the neck, and relieve neck stiffness and pain; Ashi points acted to stop pain. Combined use of these acupoints can unblock meridian and collateral, nourish spleen and boost qi, soothe liver and relieve depression, calm the mind and spirit; consequently making the patient relaxed. After treatment, he was told to perform moxibustion by himself for general healthcare. Professor CHEN says that we should not confine

1 Regulating Chronic Fatigue Syndrome

A man, aged 37. Chief complaint: Lassitude for one year and backache for one week. History of present illness: He suffered great stress at work and had slaved at a desk work for long period. One year ago, he began to experience tiredness, which was not alleviated after sleeping. In the week before the treatment, he felt tension and pain in the upper back, especially in the neck and shoulder, which became worse in busy hours. Physical examination showed restlessness and agitation, frequent sighing, aching back and shoulder, dry and sore throat, fair appetite, regular urination and defecation, disturbed sleep, a pale swollen tongue with thin whitish coating, and a thin rough pulse. Diagnosis in Western medicine: Chronic fatigue syndrome (CFS). Diagnosis in Chinese medicine: Consumptive disease. Treatment principle: Soothing liver and relieving depression, nourishing spleen and boosting qi, and calming heart spirit. Treatment procedure: Fengchi (GB 20), Fengfu (GV 16), Tianzhu (BL 10), Jingbailao (Ex-HN 15),
Fund Items: Shanghai Leading Academic Discipline Project (S30304) Author: ZHU Yi (1971- ), female, attending physician

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the indications of acupuncture to pains caused by wind and dampness. CFS people who account for 60%-70% of the total population[2], acupuncture has its unique advantages. By regulating the internal environment and reconstructing physiological balance, acupuncture shows better regulative effects than drugs from a physiological point of view. CFS, a state between health and disease, can progress to become a disease, or can restore to normal, where timely effective medical intervention is essential. Professor CHEN points out that acupuncture can prevent disease and regulate the body to reconstruct physiological homeostasis, thus becoming the optimum treatment for CFS. In terms of acupoint selection, Professor CHEN believes that Zusanli (ST 36) can enhance or regulate the digestion and absorption of the stomach and intestine, boost the bodys defense, and accelerate the removal of fatigue; Guanyuan (CV 4) can rescue many kinds of shock and boost the bodys immunity[3]. Therefore, Zusanli (ST 36) and Guanyuan (CV 4) are the primary acupoints for managing CFS. However, in clinical practice, extra acupoints can be added on the basis of syndrome differentiation or clinical symptoms to regulate the psychosomatic state.

2 Treating Autoimmune Diseases 2.1 Rheumatoid arthritis

A woman, aged 43. Chief complaint: Pain in the joints of the four limbs for 3 years. History of present illness: She experienced aching pain in the digital joints and elbow 3 years ago. The aching pain progressed slowly and the knees became swollen and painful afterwards, which were worsened in bad weather. She was diagnosed with rheumatoid arthritis in another hospital and became worried about the side effects of Western medicines, so came for acupuncture treatment. Physical examination showed low spirit, aching pain in the digital joints, elbow and knees, cold limbs, aversion to cold, poor appetite, regular urination and defecation, disturbed nighttime sleep, a darkish tongue with thin yellowish coating, and a deep small rapid pulse. Physical examination: Slightly red swollen digital joints, mild swelling in knees without deformity. Rheumatoid factor positive and erythrocyte

sedimentation rate (ESR) at 50 mm/h. Diagnosis in Western medicine: Rheumatoid arthritis. Diagnosis in Chinese medicine: Bi-impediment syndrome. Treatment principle: Clearing heat and draining dampness, harmonizing qi and blood, and unblocking meridians and collaterals. Treatment procedure: Acupoints Dazhui (GV 14), Dazhu (BL 11), Xuehai (SP 10), Dubi (ST 35), Neixiyan (Ex-LE 5) and Quze (PC 3) were used. In each treatment, 3 or 4 acupoints were pricked for bleeding and then cupped, till the blood turned from dark red to bright red; the swollen joints were pricked with injection needles, and the blood was cleaned with alcoholic cotton, till the blood turned from dark red to bright red. This treatment was conducted twice a week. Additionally, Quchi (LI 11), Chize (LU 5), Waiguan (TE 5), Baxie (Ex-UE 9), Heding (Ex-LE 2), Yanglingquan (GB 34), Zusanli (ST 36) and Sanyinjiao (SP 6) were punctured. After one treatment, the aching pain in the digital joints was relieved; the pain and swelling in the knees were eased, and she walked with less effort. After nine treatments, the aching pain in the joints was obviously improved, but sleep improved slowly. Thus, Yintang (Ex-HN 3), Sishencong (Ex-HN 1) and Shenmen (HT 7) were needled. After 20 treatments, the aching joints had noticeably improved, and ESR at 35 mm/h. The joints were pricked as before; Dazhui (GV 14) was not needled any more; in addition, Zhiyang (GV 9), Jinsuo (GV 8), Zhongshu (GV 7), Jizhong (GV 6), Mingmen (GV 4), Shenshu (BL 23) and Taixi (KI 3) were needled. After 40 treatments, all symptoms disappeared, ESR at 20 mm/h. The treatment was terminated, and she was told to do some exercise, take a rest and eat bland food. Note: When bodys healthy qi is insufficient and defense yang is inadequate, the pathogenic wind, cold and dampness invade the body, blocking meridians, causing disturbance in the qi and blood flow, hence leading to various disorders. When pathogenic factors are blocked in joints making joints painful, pricking and cupping therapies are usually used to remove blood-stasis and regulate blood flow. For aching joints of the upper limbs, Waiguan (TE 5) is needled to unblock meridians

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and move qi-blood. For aching joints of the lower limbs, Yanglingquan (GB 34) is needled; Yanglingquan (GB 34) is the influential point of sinews and acts to strengthen sinews and bones. Dazhu (BL 11), the influential point of bone, also serves to strengthen sinews and bones. After 20 treatments, the clinical symptoms had noticeably improved, indicating that the pathogenic factors were fundamentally removed. At that time, healthy qi should be reinforced by needling Taixi (KI 3), Shenshu (BL 23) and Mingmen (GV 4). After a total of 40 treatments, the clinical symptoms were controlled, and she was told to do some exercise and practice Qigong or Taichi to maintain smooth flow of qi and blood. Professor CHEN believes that rheumatoid arthritis patients have hyperactive humoral immunity and abnormal cellular immunity. Acupuncture can indeed fight against inflammation and improve joint mobility, with no side-effects for long-term use. Clinical experience has shown that acupuncture works better on excess-syndrome patients than on deficient-syndrome patients. However, the effects of acupuncture are affected by many factors, such as the severity and duration of disease, treatment course and bodys immunity. Therefore, for some patients, Chinese medicine and/or Western medicine should be combined with acupuncture. 2.2 Ulcerative colitis A man, aged 56. Chief complaint: Recurrent onset of diarrhea and abdominal pain for over five years, getting progressively worse during the last month. History of present illness: In March 2003, he suddenly developed diarrhea after eating raw and cold food, more than 10 times a day, with a little mucus and blood. After transfusion the diarrhea was improved, but it had sometimes reoccurred during the last five years. One month ago, he suffered from diarrhea again after eating excessive raw and cold food, 7-8 times a day, watery stools with large amount of mucus and blood; accompanied by aching loin and knees, cold limbs, diminished appetite and tiredness, abdominal pain preferable to warmth and pressure, abdominal distension and rumbling, a pale swollen tongue with teeth marks, whitish moist coating, and a deep small pulse.

Physical examination: Emaciation, sallow complexion, lassitude, abdominal tenderness, and hyperactive bowel sounds. Laboratory examination: In 2004, colonoscopy showed congested and erosive mucosa, and multiple ulcers of 0.3 cm 0.1 cm, primarily in the left hemicolon; biopsy for the mucosa 30 cm away the anus showed chronic mucous inflammation. Diagnosis in Western medicine: Ulcerative colitis. Diagnosis in Chinese medicine: Diarrhea. Treatment principle: Warming and reinforcing spleen-kidney, securing intestine to stop diarrhea. Treatment procedure: Acupoints Zhongwan (CV 12), Tianshu (ST 25), Guanyuan (CV 4), Mingmen (GV 4) and Zusanli (ST 36) were treated with herbal cake-partitioned moxibustion; in addition, Pishu (BL 20), Shenshu (BL 23), Dachangshu (BL 25), Taixi (KI 3) and Shangjvxu (ST 37) were punctured with filiform needles, whose handles were covered with moxa sticks and two sessions of moxa for each acupoint. This treatment was conducted once a day and 12 treatments made up one course. There was a 3-day interval between any two courses. A total of 72 treatments were given and no relapse has been found up to the present day. He was told not to get cold and avoid spicy and fried foods, seafood and milk products; to do proper exercise to enhance the bodys constitution. In September 2008, the colonoscopy showed absence of congestion, erosion or ulcer of mucous membrane. Note: Professor CHEN holds that ulcerative colitis is not just a localized colon disease, also a systemic disease. It is primarily caused by exogenous dampness heat and toxin, or by deficient spleen failing to transform and transport, and ensuing accumulation of dampness-heat. Therefore, ulcerative colitis is a combination of heat and cold, deficiency and excess; and its pathogenesis lies in spleen deficiency or spleen-kidney yang deficiency. This patient suffered from diarrhea for a long time; though the large intestine is directly affected, the spleen and stomach have a imbalance in essence; diarrhea at dawn signifies spleen-kidney yang deficiency. Treatment aims to warm and reinforce the spleen and kidney, secure the intestine and arrest diarrhea. Moxibustion can warm the meridian and disperse cold, unblock the collateral and relieve pain,

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uplift yang qi, restore yang and arrest the collapse. This patient was treated mainly by moxibustion. Tianshu (ST 25) was used to secure the intestine and arrest diarrhea; Guanyuan (CV 4) was used to strengthen root and enrich essence; Mingmen (GV 4) was used to warm kidney and supplement fire; Zhongwan (CV 12), the Front-Mu point of the stomach, and Zusanli (ST 36), the He-Sea point of the stomach, were used to strengthen the spleen and stomach. Pishu (BL 20), Shenshu (BL 23), Taixi (KI 3), Shangjvxu (ST 37) and Dachangshu (BL 25) were adopted to warm and reinforce the spleen and kidney, uplift spleen qi, harmonize yin and yang, secure the intestine and arrest diarrhea.

3 Shoulder Periarthritis
A woman, aged 50. Chief complaint: recurrent pain in the right shoulder for 2 years, progressively worse in the last month. History of present illness: Two years ago, she developed pain in the right shoulder, which was diagnosed as periarthritis of the right shoulder in another hospital. After treatment by Fenbid, her clinical symptoms were improved. One month ago, the right shoulder got painful around the whole shoulder after being exerted, worse at night and relieved in the daytime. Physical examination showed confined movement of the right shoulder in lateral torsion, upward lifting and backward torsion; apparent tenderness around the shoulder, fair appetite, regular urination and defecation, disturbed nighttime sleep, a dark red tongue with whitish coating, and a thin pulse. Physical examination: There was apparent tenderness at the right-shoulder Jianqian [Extra, the mid-point of the line between the upper end of anterior axillary fold and the point Jianyu (LI 15)], Jianyu (LI 15) and Jugu (LI 16), confined lateral torsion, abduction, upward lifting and backward torsion, shoulder pain when uplifted over 60. X-ray examination: No evident abnormality in the right shoulder. Diagnosis in Western medicine: Shoulder periarthritis. Diagnosis in Chinese medicine: Bi-impediment syndrome. Treatment principle: Activating blood and resolving blood-stasis, unblocking collateral and

relieving pain. Treatment procedure: She took a seat. After routine disinfection, the most obvious tenderness point was tapped with plum-blossom needle. When bleeding, the point was cupped for 5-6 min. Afterwards, Jianqian (Extra), Jianyu (LI 15), Jugu (LI 16) and Ashi points were punctured with filiform needles, whose handles were covered with ignited moxa stick, two sticks for each point. After the removal of the needles, 4 mL of Dan Shen (Radix Salviae Miltiorrhizae) Injection was injected into the 4 acupoints, 1 mL for each point. After 5 treatments, the shoulder pain was relieved; and 9 treatments later, the pain disappeared. Note: Professor CHEN states that innovation of primitive acupuncture is very difficult today, but complex acupuncture therapy has broad prospects. Needling, electroacupuncture and drug injection at acupoints combine acupoint functions, acupoint stimulating techniques and drugs. They may be the new approaches to innovation of acupuncture therapy, and can enhance clinical efficacy. For example, in the treatment of shoulder periarthritis by acupuncture, early shoulder periarthritis with severe pain or inability to fall asleep during nighttime can be treated by electroacupuncture or acupoint injection with anti-inflammatories and analgesics to relieve pain and eliminate inflammatory edema; late shoulder periarthritis with adhesion, dysfunction and intractable pain can be treated by pricking to bleed, cupping, acupoint injection with herbs which are effective in activating blood flow and resolving blood-stasis, as well as moxibustion. During the three-year studies, I find that Professor CHEN Han-ping pays great attention to the regulative effects of acupuncture in the treatment of CFS, and to a comprehensive use of many acupuncture therapies.

References
[1] WEI Yu-lin. Stress-Depression-Subhealth State. Health for the Elderly and Middle-aged, 2002, (10): 37-38. [2] ZHOU Ling-ling. Advances in Study on Sub-clinical Health Status. Journal of Environmental and Occupational Medicine, 2005, 22 (5): 480. [3] CHEN Han-ping. Approach to Acupuncture. Shanghai: Shanghai University of Traditional Chinese Medicine Press, 2007: 147. Translator: XIAO Yuan-chun () Received Date: November 2, 2009

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