Neurological Disorders and Integrative Medicine

1. Neurological Disorders and Integrative Medicine Advances in Neurology and Neurosurgery Community Lecture Riviera Hotel, Palm Springs Cedars-Sinai Medical Center, October 26, 2013 Lucy Postolov, L.Ac. Master of Traditional Oriental Medicine Diplomat in Acupuncture (NCCAOM) Allied Health Professional for Cedars-Sinai Medical CenterBoard Certification in Integrative Medicine

2. Integrative Medicine is a part of Modern Medicine • Mainstream Medicine • Allopathic Medicine • CAM • Complementary and Alternative Medicine

4. NCCAM Groups CAM ModalitiesInto Five Major Domains • Alternative Medical Systems • Traditional Oriental Medicine and Homeopathy • Mind-Body Intervention • Meditation, Imagery, Relaxation • Biologically-Based Treatments • Herbals, High-Dose Vitamin Therapy, Enzyme Therapy • Manipulative and Body-Based Approaches • Massage, Yoga, Chiropractic • Energy Therapy • Qi Gong, Reiki, Therapeutic Touch

5. Five Major Domains

6. NIH Consensus Development Panel on Acupuncture Promising results have emerged, for example, showing efficacy of acupuncture in adult postoperative and chemotherapy nausea and vomiting and in postoperative dental pain. There are other situations, such as addiction, strokerehabilitation, headache, menstrual cramps, tenniselbow, fibromyalgia, myofascial pain, osteoarthritis, low back pain, carpal tunnel syndrome, and asthma, in which acupuncture may be useful as adjunct treatment or an acceptable alternative or be included in a comprehensive management program. Further research is likely to uncover additional areas where acupuncture interventions will be useful. JAMA. 1998;280:1518-1524

7. Integrative Medicine Helps to Diminish the Symptoms of Neurological Disorders • Post Stroke Symptoms • Headaches (including migraines) • Lumbalgia • Cervicalgia • Post Operative Pain • Multiple Sclerosis • Bell’s Palsy • Parkinson Disease • Neuralgia • Epilepsy • Brain & Spine Tumors

8. How Acupuncture Works The Eastern Philosophical Point of View

9. How Acupuncture Works The Western Medical Point of View From “Neuro-Acupuncture”, Cho ZH et al, Q-puncture, Inc. 2001

10. Pain Management • Naloxone blocks acupuncture-induced analgesia indicating CNS endorphin involvement • Acupuncture increases the availability of µ-opiod receptors • Effect unachievable via sham acupuncture (placebo). Percent change MOR binding potential From “The Neuroanatomic Basis of the Acupuncture Principal Meridians”, Dorsher PT et al, Mayo Foundation for Medical Education and Research 2009 and “Traditional Chinese acupuncture and placebo (sham) acupuncture are differentiated by their effects on µ-opiod receptors (MORs)”, Harris RE et al. Elsevier Inc. 2009

11. A Systematic Review and Meta-Analysis of Randomized Trials Acupuncture in Post stroke Rehabilitation Background and Purpose – Acupuncture is a low-risk treatment with purported claims of effectiveness for post stroke rehabilitation. Method – 7 English and 2 Chinese databases from inception to September 2009. Result – Thirty-five articles written in Chinese and 21 articles written in English were included. Conclusion – Randomized clinical trials demonstrate that acupuncture may be effective in the treatment of post stroke rehabilitation. From”Acupuncture in Poststroke rehabilitation”, Ping Wu, MD, MSc; Edward, MSc, PhD; David Moher, MSc, PhD; Dugald Seely, ND, MSc. Stroke Published Online, Feb 18, 2010

12. A Systematic Review and Meta-Analysis of Randomized Trials Acupuncture in Post stroke Rehabilitation Stroke is responsible for increasingly high rates of mortality and disability worldwide. Due to an aging population, dietary changes, and work-related stress. According to the latest data issued by the American Heart Association, each year approximately 600,000 people experience a new stroke and 185,000 a recurrent stroke. The cost of care has risen from $53.6 billion in 2004 to $68.9 billion in 2009. From”Acupuncture in Poststroke rehabilitation”, Ping Wu, MD, MSc; Edward, MSc, PhD; David Moher, MSc, PhD; Dugald Seely, ND, MSc. Stroke Published Online, Feb 18, 2010

13. A Systematic Review and Meta-Analysis of Randomized Trials Acupuncture in Post stroke Rehabilitation From”Acupuncture in Poststroke rehabilitation”, Ping Wu, MD, MSc; Edward, MSc, PhD; David Moher, MSc, PhD; Dugald Seely, ND, MSc. Stroke Published Online, Feb 18, 2010

14. An Increasing Number of Cancer Patients are Turning to Complementary and Alternative Medicine (CAM) CAM use among cancer patients is diverse and varies by region • National Center for CAM estimates • 7-54% of cancer patients use CAM • 48-88% of cancer patients used CAM while being treated in comprehensive cancer centers in the USA

15. Clinical Applications of Acupuncture for Patients with Cancers Chemotherapy Related Side Effects • Myelo-suppression: with leucopenia, thrombocytopenia, anemia • Nausea • Vomiting • Mucositis (mucus membrane ulceration) Radiotherapy Induced Symptoms • Xerostomia (Dry mouth condition caused by radiation) Symptom Management • Cancer Pain

16. Other Symptoms as a Result of Chemotherapy Toxicity Other Symptoms CNS Toxicity • Insomnia • Fatigue • Mood Disorder • Feeling a Loss of Control Loss of Appetite Weakened Immune System Alopecia

17. Other Clinical Issues • Cancer Treatment Induced Early Menopause • Chemotherapy-Induced Diarrhea or Constipation • Post-Operative Pain • Neuropathy • Skin Reaction • Liver Toxicity • End of Life Care

18. Acupuncture helps tolook and feel beautiful after cancer related treatments • Facial Rejuvenation • Weight loss OR gain • Return of sexual desire • Gain the energy back • Balance of hormones • Micro Currency TX

19. Risk of Harm Associated with Non-Conventional Approaches to Cancer Management • Symptom control of nausea and vomiting should be initiated after underlying causes have been identified • Claims to “cure” cancer with natural and non-toxic treatment • Herb-drug interactions • Side effects associated with unsafe and unregulated non-conventional interventions

20. Requirements for Acupuncturists Working with Oncology patients • Acupuncture License • National (optional) • State (required) • General Medical Training Background • Hospital System Experience • Good Communication Skills • Experience Treating Oncology Patients

21. Chinese Herbal Medicine to Support Patients Going Through Chemo and Radiation Bu Zhong Yi Qi Tang Ren Shen Ginseng Rx. Bai Zhu Atractylodis Alba Rz Huang Qi Astragali Rx Dang Gui Angelicae Sinensis Rx Dao Zao Jujubae Fr. Chen Pi Citri Reticulatae Pc. Chai Hu Bupleuri Rx. Zhi Gan Cao Glycyrrhizae Rx. Preparata Sheng Jiang Zingiberis Recens Rz Sheng Ma Cimicifugae Rz.. Chemo-Support Huang Qi Radix Astragali Ren Shen Radix Ginseng Ling Zhi Ganoderma Xi Yang Shen Radix Panacis quinquefolii Mu Dan Pi Cortex Moutan Zhi Mu Radix Anemarrhenae Fu Ling Poria Chen Pi Pericarpium Citri reticulatae Mai Men Dong Radix Ophiopogonis Dang Gui Radix Angelicae sinensis Ban Xia Rhizoma Pinelliae Preparatum Lu Gen Rhizoma Phragmitis Nu Zhen Zi Fructus Ligustri lucidi Sha Ren Fructus Amomi Huang Jing Rhizoma Polygonati Gan Cao Radix Glycyrrhizae uralensis Radio Support Huang Qi Radix Astragali Dang Gui Radix Angelicae sinsis Hong Hua Flos Carthami tinctorii Dan Shen Radix Salviae miltiorrhizae Shou Wu Radix Polygoni multiflori preparata Gou Qi Zi Fructus Lycii chinensis Wu Wei Zi Fructus Schisandrae Nu Zhen Zi Fructus Ligustri lucidi Zhi Mu Radix Anemarrhenae Mu Dan Pi Cortex Moutan Gan Cao Radix Glycyrrhizae uralensis Sheng Di Huang Radix Rehmanniae Chen Pi Pericarpium Citri reticulatae Yu Zhu Rhizoma Polygonati odorati

22. Analysis of Individual Herbsin Chemo SupportPharmacology of Chemo Support Ingredients Huang Qi- Radix Astragali Membranacei • Enhancement of Immune Function The decoction given to mice increases the phagocytic activity of the reticuloendothelial system. • Antibacterial Effect In vitro was effective against Shigella Shigae, Bacillum anthracis, Streptococcus hemolyticus, and Staphyloccus aureus. • Effect on endurance Decoction of Huang Qi given to mice significantly increase the endurance in swimming tests.

23. Alternative Treatments for Epilepsy • 1. Diet (Ketogenic) • 2. Acupuncture • 3. Art Therapy • 4. Breath work • 5. Prayer and Spirituality • 6. Meditation

24. Current Research on Alternative Therapies Cohen, Lorenze and Markman, Maurie. Integrative Oncology. p 126. Huston, TX. 2008 Humana Press.

26. Maciocia, Giovanni, The Three Treasures NewslettersAutumn, 1999. • Perry M, Anderson C, Dorr V, Wilkes J, The Chemotherapy Sourcebook, Williams & Wilkins, Baltimore, Maryland, 1999. • Skeel R, Handbook of Cancer Chemotherapy, Williams & Wilkins, Baltimore, Maryland, 1999. • Zhu YP, Chinese Materia Medica, Harwood Academic Publishers, Amsterdam, 1998. • Bensky D and Gamble A, Chinese Herbal Medicine Materia Medica, Eastland Press, Seattle, 1993. • Chang H.M. and But P.P. Hay, Pharmacology and Applications of Chinese Materia Medica, World Scientific, Hong Kong, Vol. I, 1986., World Scientific, Hong Kong, Vol. I, 1986. • Dorsher PT, “The Neuroanatomic Basis of the Acupuncture Principal Meridians”, Mayo Foundation for Medical Education and Research 2009. • Harris RE et al.“Traditional Chinese acupuncture and placebo (sham) acupuncture are differentiated by their effects on µ-opiod receptors (MORs)”, Elsevier Inc. 2009. • Cohen, Lorenze and Markman, Maurie. Integrative Oncology. p126. Huston, TX. 2008 Humana Press. • Kathleen K.S.Hui, Jing Liu, Niko Makris, Randy L. Gollub, Anthony J.W. Chen, Christopher I. Moore, David N. Kennedy, Bruce R.Rosen, and Kenneth K. Kwong. “Acupuncture Modulates the Limbic System and Subcortical Gray Structures of the Human Brain: Evidence From fMRI Studies in Normal Subjects”, Massachusetts, 2000 • Li Q, Chen X, He L, Zhou D. “Traditional Chinese Medicine for epilepsy” Department of Neurology, West • China Hospital, Sichaun University, Guo xue xiang No. 37, Chengdu, Sichuan, China, 610041 • Liow K, Ablah e. Nguyen Jc, Sadler T et al. “ Pattern and frequency of use of complementary and alternative • Medicine among patients with epilepsy in the Midwestern United States” Via Christi Comprehensive • Epilepsy Center and neurophysiology laboratory, Wichita, KS USA • Acupuncture in Post stroke rehabilitation”, Ping Wu, MD, MSc; Edward, MSc, PhD; David Moher, MSc, PhD; Dugald Seely, ND, MSc. Stroke Published Online, Feb 18, 2010. • Ping Wu, MD, MSc; Edward, MSc, PhD; David Moher, MSc, PhD; Dugald Seely, ND, MSc. “Acupuncture in Poststroke rehabilitation”. Stroke Published Online, Feb 18, 2010. • Levy R, Cooper P. “ Ketogenic diet for Epilepsy”. Royal Albert Edward Infirmary, Wigan Lane, Wigan, • UK, WN1 2 nn Bibliography