Acupuncture for Causalgia

肢端紅痛症

cau·sal·gi·a

[kôˈzalj(ē)ə, -ˈsal-]

Causalgia Toes during a burning flare

Toes during a burning flare

https://en.wikipedia.org/wiki/Erythromelalgia

 

Causalgia is a pain syndrome manifest with severe burning pain in a limb caused by injury to a peripheral nerve.  The disease also known as reflex sympathetic dystrophy (RSD), or a newer medical term called Complex Regional Pain Syndrome (CRPS).

 

 

chronic neuropathic pain syndromes

“Of all the chronic neuropathic pain syndromes, none has perplexed patient, clinician, and scientist more than the complex regional pain syndromes (CRPS), heretofore known as reflex sympathetic dystrophy (RSD) and causalgia.”

Complex Regional Pain Syndrome (CRPS) or Reflex Sympathetic Dystrophy (RSD)

 

There is another autonomic nerve system illness that I see in my clinic, with similar ANS problems but manifest quite differently from Raynaud’s (ray-NOHZ) disease, called Causalgia. Raynaud’s is more prevalent to young female, causalgia is more seen with young man.  As of the reason why and what causes these autonomic nerve system disease, both are unknown.  One things seem in common is that we can noticed that patient usually are likely been lack of exercise, as well as easily seen frostbite in winter season; for those women whom suffered from this disease are usually seen Irregular menstrual periods or to have sweaty palms.  Causalgia can be secondary to some diseases such as thrombotic angiitis(vasculitis), Diabetic peripheral neuropathy, Scleroderma, Polycythemia Vera, Syringomyelia, advanced skin lesions of nutritional change, such as thickening of the nails, or small ulcers forming at the tip of the fingers.

 
Erythromelalgia in a 77-year-old woman with longstanding

Erythromelalgia in a 77-year-old woman with longstanding polycythemia Vera.

https://en.wikipedia.org/wiki/Erythromelalgia

 

Diagnose

Redness, swelling, hot, pain accompany with burning and stinging sensation, pain is worse in the night, as standing, walking and sitting can all trigger the pain, patient liked to raise their legs and stay in cooler environment.

localized skin is hyperemia and warm or hot to touch, skin temperature can be raised moderately.  Mild swelling and sweating, localized tactile hyperalgesia and no sensory loss or motor disorders.

 

 

 

 

Treatment

  1. Treatment using Jia-Ji points:

Jia-Ji points from T1 to T5, lumbar area L1 to L3.

Retain needles for 30 minutes, 10 treatments as one session.

 

  1. Treatment using localized acu-points:

足三里  ST-36, 陽陵泉  GB-34, 三陰交  SP-6, 太溪  KI-3,太衝 LR-3,

俠溪 GB-43。

Retain needles for 30 minutes, 10 treatments as one session.

 

  1. Treatment using back side Shu-Point:

For upper limbs – 闕陰兪 BL-14, 心兪 BL-15, 膈兪 BL-17。

For lower limbs – 脾兪 BL-20, 胃兪 BL-21, 腎兪 BL-23。

Retain needles for 20 minutes, 10 treatments as one session.

 

Personal experience and conclusion:

Personally, I like to utilize ONLY the Jia-Ji Points because I have noticed that by using Jia-Ji Point Treatment sees much faster improvement and good prognosis.  I have been carefully avoiding those localized point or acu-point in the focus areas, as I have found that the situation can become worse, or stimulations can just triggered another new attack.

 

 

 

 

You can find more of the general medical information of Causalgia/RSD/CRPS in these websites:

https://en.wikipedia.org/wiki/Causalgia

www.causalgia.com

http://www.mayoclinic.org/diseases-conditions/complex-regional-pain-syndrome/basics/definition/CON-20022844

http://painmd.tv/crps/

 

This article is written by Larry Han, AP

Acupuncture Treatment Center

www.jacksonvilleacupuncture.com

www.orangeparkacupuncture.com

April 8, 2017

My clinical experience in treating Raynaud’s Disease

Larry Han, AP

個人在治療雷諾氏症的觀察和體驗,韓羅維 美國佛羅里達州中醫師

I have been seeing patients with Raynaud’s Disease for long time, realized it can be difficult and complicate, you see common symptoms yet every single case has its own causes, this is why that I am always amazed and remind myself to always keeping the humble and learning attitude about the disease.  Often times patient come to clinic believing that they have the disease, when they learned all they have was just merely cold hands and feet, turn out to be a wonderful ending for both patient and myself.

Acral artery spasms also known as Raynaud’s Disease, it is one type of neurological, vascular disorders (peripheral vascular dysregulation).  Cause is unclear yet it is related to the autonomic nervous system dysfunctions.

When secondary to certain diseases, it is called Raynaud’s phenomenon. The disease often occurs in young women, especially those who are easy to get nervous.  Exposed to cold air, or drastic emotional change can induce attack.

Diagnosis: slow onset, usually after exposure to cold environment, especially after the finger (toe) in contact with the cold water.  Often seen in distal extremities, mainly the fingers.  Pale white fingers are symmetry, then cyanosis can be noticed.   often starting from the fingertips, gradually move to the fingers, palm.  accompanied by localized cold, numbness, pricking-like pain, or other paresthesia.

Radial artery or dorsalis pedis pulse can be normal or weaken, attack remission after several minutes. Skin turns to flushing then returned to normal, so as the skin temperature.  There are no particular symptoms other than cold hands or feet during remission.

Affected areas can also be seen in other parts of the body, such as the nose, lips, ears and even nipples and so on.

 

Raynaud’s Diseas

【See Above pictures.  Acupuncture offers effective and significant result in treating Raynaud’s disease, gangrene is diminishing with scab and new granulation grown on the 36th day from the beginning of the treatment shown in picture. 】

 

 

Recurrence 復發的治療

 

In July 2012, same patient had another serious attack of Raynaud’s Disease. Again, it was acupuncture helped with the situation, see following dated pictures.

serious attack of Raynaud’s Disease

Raynaud’s Disease

Raynaud’s Disease

 

Acu-points used in acupuncture treatment:

  1. Jia-Ji treatment:

Primary acu-point should be in the lower cervical, upper thoracic as well as lumbar region.

  1. Localized distribution acu-point:外關SJ5 ,合谷 LI4,後溪 SI3 ,足三里 ST36, 太溪KI3 ,太衝 LR3 ,俠溪 GB43 。

Operation: reducing method.

  1. Acupuncture with Elec-stimulation:

Prescription:曲池 LI11 ,外關 SJ5 ,內八邪,太谿 KI3 ,太衝 LR3,

足三里 ST36。

use sparse continues wave,frequency 1 Hz, negative connect to distal acu-point and positive to the proximal,15~30 minutes in each treatment.

  1. Personal experience:

First, acupuncture can quickly act on the pain, neurotransmitters such as catecholamine’s can also reduce the stress and anxiety induced phenomena’s.  As the disease relapsed or during remission stage, herbal treatment can be considered.

I some time prescribed herbal prescription called Wen-Yang Tong-Mai-Yin, was developed by Professor Gao Weibin, I used herbs to help consolidate and effectiveness of the treatment, or to use it for those who cannot come to continue the acupuncture treatments.

Formula usually consist of Fu-Zi (Aconite), Wu-Zhu-Yu (Evodia), Huang-Qi (Astragalus), Dang-Shen (Codonopsis), Dan-Shen (Salvia), Chi-Shao (TPG), Dang-Gui (Angelica), Gui-Zhi (cassia twig), as well as others to be added base on patient’s condition.

Pharmacological analysis of these herbs:

Fu-Zi (Aconite) and Wu-Zhu-Yu (Evodia) both Belongs to tonify Yang herbs that containing higenamine with β-adrenergic receptor agonists like effects, worked to expand the skeletal muscle blood vessels, reducing peripheral vascular resistance.

Huang-Qi (Astragalus) and Dang-Shen (Codonopsis) can enhance adrenal function, improve body’s adaptability, expand blood vessels, reducing vascular resistance.

Salvia, TPG expansion limbs blood vessels and improve peripheral circulation.

When adding together Angelica, cassia twig and Evodia can effectively increase skin temperatures.

 

【Raynaud’s Disease cause and treatment from a western medicine point of view】

Presently the cause for Renault disease is still unclear, overreaction to cold environment, anxiety and emotional change seems also have associated with the condition. Vasospasm may cause long-term harden and thickening of the small arteries can further worsen the situation.

Primary Raynaud’s Disease
Also known as Raynaud’s disease, the majority of Renault’s disease fall into this category, the cause is unknown, there is no specific predisposing conditions.

The second category of Raynaud’s disease, also known as Raynaud’s phenomenon, which has a specific incidence of the condition, although cases number is relatively small, but symptoms are much more severe. Usually pathogenesis seen in the middle age, about 40 years old.

Cause for Raynaud’s phenomenon may include the following:

Connective tissue disease: for example, scleroderma patients can also have Raynaud’s phenomenon. Other risk includes lupus, rheumatoid arthritis, Sjogren’s syndrome.

Artery disease: :動脈硬化 atherosclerosis,伯格氏病 Buerger’s ‘s disease, 原發性肺動脈高壓 primary pulmonary hypertension。

Carpal tunnel syndrome.  Long hours of repeating

Long-term and repeated hand exertion, such as the piano practicing, continuous using pneumatic tools.

Smoking, side effects of certain drugs such as beta blockers; migraine drugs containing ergotamine or sumatriptan; drugs for ADHD or drugs for inattentions, even cold medicine, etc. are likely to cause vasoconstriction phenomenon and leading to attack.

Injuries: wrist and ankle contusion, surgery and frostbite may also induce the disease.

 

Primary Raynaud’s disease morbidity and risk factors include:

Gender: Women were more common

Age: between 15 to 30 years old

Climate: Cool Region

Family history: 1/3 of patient’s first-degree relatives has higher incidence, such as parents, siblings, children, etc.

Risk factors for the second category which is the Raynaud’s phenomenon are:

Related diseases: scleroderma or lupus erythematosus.

Certain occupations: Some job can cause repeated trauma, such as vibration-type tools.

Hazardous substances: smoking, drugs, chemicals, such as vinyl chloride vinyl chloride.

Complications:

Rare and severe Raynaud’s disease may lead to a permanent fingers and toes deformity, resulting from long-termed blood supply reduction.

When attacking area is having a completely blood supply cut off, skin ulcers and gangrene will happen immediately. Ulcers and gangrene are difficult to treat, usually ended with amputation.

 

Prognosis

Once Raynaud symptoms (primary or secondary) has been confirmed, patient would have to go through life time treatment. In the case of Renault phenomenon, the situation is more complicated and difficult; patients usually develop adaptation to the drug, not only reduce the efficacy, but the symptoms will be more frequent and more severe.

 

Treatment and Research

The current study is primarily focused on an enzyme that connect with vasoconstrictions called tyrosine kinase (human proteins), it is associated with heredity.

There are several new treatment options are being conducted, including BOTOX® therapy, Viagra®, traditional Chinese medicines such as ginkgo biloba, and St. John’s wort.

Prognosis for Raynaud’s Disease

Once primary or secondary Raynaud’s develops, the condition usually must be managed over the course of the patient’s lifetime. Although Raynaud’s attacks can be stressful, it is important to remain patient, follow your doctor’s instructions, and be open to other therapies if necessary.

Patients who have secondary Raynaud’s may have an especially difficult time. Treatment options often require adjustments because medications can become ineffective over time and the attacks can occur with more frequency and severity.

Renault’s Disease Disease Research

Researchers are studying possible causes for primary Raynaud’s Disease. Ongoing studies are focused on genetic links and on the role that a protein called tyrosine kinase (PTK; an enzyme involved in constricting blood vessels) may play in development of the condition.

A number of new treatment options also are being studied. These treatments include using botulinum toxin injection therapy (BOTOX® therapy), Viagra®, and herbal therapies (e.g., ginkgo biloba, St. John’s wort) to treat Raynaud’s Disease.

Publication Review by: Stanley J. Swierzewski, III, M.D.

Published: 03 Nov 2008

Last Modified: 21 Sep 2010

http://www.healthcommunities.com/raynauds-disease/prognosis-research.shtml

 

韓羅維 Larry Han, AP

February 14, 2016

 

 

No, you do not have a sciatica

 

 

I hear this almost every day, “doc, they said that I have sciatica”.  In reality, the lower back pain patients I’ve seen, the chances of seeing a real sciatica patient is probably less than 0.1%, the rest, were just commonly lower back pain accompanied with symptoms mixed from pain in the hip, around the thigh, occasionally some of them can have unrelated knee or leg discomfort.

 

Since patients have no reason to exaggerate about their conditions, I often wonder what had happened, where had patient’s been to, and whom had given them the wrong information.  As much as I do not want to think of, what was the reason or benefit to motivate health care professionals not to tell patient the truth.

 

Following are some of the most possible reason to give one a true sciatic irritation, see if you have, and they are:

 

  1. Intervertebral disc protrusion
  2. Spinal stenosis
  3. Spondylolisthesis
  4. Severe lumbar region trauma
  5. Piriformis syndrome
  6. Spinal tumors

 

Since most of you will not have severe conditions mentioned above, now try to think back, did the practitioner had perform any of these test before they send you for an imaging test, for example, one of the 11th manual test like the following’s: (photos of each are shown at the bottom of this article)

 

  1. Bowstring test
  2. Piriformis stress test
  3. Fabere Test | Patrick’s Test
  4. Trendelenburg Test and gluteus medius test
  5. Bechterew’s Test
  6. Slump Test
  7. Turyn’s Test
  8. SLRT Straight leg raise test
  9. WLRT Well leg raise test
  10. Bragard’s Test
  11. Bonnet’s Test

 

Reason that these initial manual tests are important, is because they can do few things for you:

 

  1. They should be very easy to tell what could possibly the pain came from,

These test are very good to help differentiate between a piriformis

syndrome, a strain gluteus muscle, for example, a gluteus medius

syndrome.

  1. Avoid to have you waste time and unnecessary cost, say MRI, another

example.

  1. Initiate an appropriate and immediate treatment right there at that very

moment.

 

Equally important, practitioner whom performed the checkup for you, did they:

 

  1. Asked how long ago was this happened, and what had cause this
  2. Level of pain from a scale of 1 to 10
  3. Having you described the exact area(s) of the pain
  4. Having you described if there are any muscle weakness, furthermore, is

muscle atrophy obvious?

  1. Having you circled on an anatomical chart to show the tingling and

numbness on the skin

  1. Did you noticed a foot drop?
  2. What other symptoms did you have?
  3. Did imaging tests such as X-Ray or MRI been used to help identify the

root of the problem?

(Remember, to trust only the X-Ray that is done by a radiologist, even

more importantly, that is, it comes with the radiologist diagnosis and

signatures)

 

 

If, none of the above was done, or did it sloppily, you maybe turnout never had the problem, possibly you have had some bad sprain’s, some bad and chronic strain in the pelvic sacroiliac joint, you may have injured the cutaneous nerve of the gluteus, you may have pulled your TFL’s (tensor fascia lata muscle), all in all, very possibly, it was never a sciatica, well, what should I say, congratulations?

 

Just don’t let this happen to you

In United States, the number of unnecessary medical and surgical procedures performed annually is 7.5 million (2014). The number of people exposed to unnecessary hospitalization annually is 8.9 million.

Annually, between 20 million and 25 million surgical procedures are carried out among all the specialties except plastic surgery. The study determined that between 15% and 29% were unnecessary. For example, 27% of the women who had hysterectomies, the second most common surgery, didn’t need the operation!
An excerpt from:

Unnecessary surgery exposed! Why 60% of all surgeries are medically unjustified and how surgeons exploit patients to generate profits

http://www.naturalnews.com/012291.html

 

 

 

 

 

 

 

 

 

 

 

  1. Bowstring test

 

bowstring test

 

2. Trendelenburg Test and gluteus medius test

Trendelenburg-Sign

3. Bechterew’s Test

acupuncture Bechterew’s test

4. Bragard’s Test

acupuncture for Bragard’s test