Chinese Medicine in Support of the Treatment of Patient with Neurological Disorders

1. Chinese Medicine in Support of the Treatment of Patient with Neurological Disorders Advances in Neurology and Neurosurgery Patient Conference Hyatt Regency Palm Springs Cedar-Sinai, June 4th, 2011 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 • Complimentary and Alternative Medicine

3. 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

4. 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

5. Chinese Medicine Helps to Diminish the Symptoms of Neurological Disorders • Stroke • Headache (including migraines) • Low Back Pain • Multiple Sclerosis • Bell’s Palsy • Parkinson Disease • Neuralgia

6. How Acupuncture Works The Eastern Philosophical Point of View

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

8. Band-like innervations of trunk consistent with segmental organization of trunk meridians Principle Meridians as TCM’s Representation of the Nervous System From “The Neuroanatomic Basis of the Acupuncture Principal Meridians”, Dorsher PT , Mayo Foundation for Medical Education and Research 2009

9. From “Cerebral Blood Flow Effects of Pain and Acupuncture: A Preliminary Single-Photon Emission Computed Tomography Imaging Study”. By, Andrew B. Newberg, MD., Patrick J. LaRiccia, MD., Bruce Y. Lee, MD., John T. Farrar, MD., Lorna Lee, MA., and AbassAlavi, MD. The American Society of Neuroimagining, April 27th, 2004.

10. From “Acupuncture Modulates the Limbic System and Subcortical Gray Structures of the Human Brain: Evidence From fMRI Studies in Normal Subjects”, Kathleen K.S. Hui, Jing Liu, Nikos Makris, Randy L. Gollub, Anthony J.W. Chen, Christopher I. Moore, David N. Kennedy, Bruce R. Rosen, and Kenneth K. Kwong. The Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts. December 29th, 1998

11. From “Hypothalamus and Amygdala Response to Acupuncture Stimuli in Carpal Tunnel Syndrone”, By, V. Napadow, N. Kettner, J. Liu, M. Li, K. K. Kwong, M. Vangel, N. Makris, J. Audette, and K. K. S. Hui. Department of Radiology, Massachusetts General Hospital, Charlestown, MA. November 21st, 2006.

12. 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

13. 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 Poststrokerehailitation”, Ping Wu, MD, MSc; Edward, MSc, PhD; David Moher, MSc, PdD; DugaldSeely, ND, MSc. Stroke Published Online, Feb 18, 2010

14. 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 Poststrokerehailitation”, Ping Wu, MD, MSc; Edward, MSc, PhD; David Moher, MSc, PdD; DugaldSeely, ND, MSc. Stroke Published Online, Feb 18, 2010

15. A Systematic Review and Meta-Analysis of Randomized Trials Acupuncture in Post stroke Rehabilitation Statistical Analysis – The use of OR was used for meta-analysis as a patients begin with the disease (stroke) and we are examining events as a decrease in disease (rehabilitation). Characteristics of Included Studies – The 56 randomized clinical trials included 5650 patients, 3156 in treatment groups and 2494 in the control groups. From”Acupuncture in Poststrokerehailitation”, Ping Wu, MD, MSc; Edward, MSc, PhD; David Moher, MSc, PdD; DugaldSeely, ND, MSc. Stroke Published Online, Feb 18, 2010

16. A Systematic Review and Meta-Analysis of Randomized Trials Acupuncture in Post stroke Rehabilitation From”Acupuncture in Poststrokerehailitation”, Ping Wu, MD, MSc; Edward, MSc, PhD; David Moher, MSc, PdD; DugaldSeely, ND, MSc. Stroke Published Online, Feb 18, 2010

17. From”Acupuncture in Poststrokerehailitation”, Ping Wu, MD, MSc; Edward, MSc, PhD; David Moher, MSc, PdD; DugaldSeely, ND, MSc. Stroke Published Online, Feb 18, 2010

18. From”Acupuncture in Poststrokerehailitation”, Ping Wu, MD, MSc; Edward, MSc, PhD; David Moher, MSc, PdD; DugaldSeely, ND, MSc. Stroke Published Online, Feb 18, 2010

19. A Systematic Review and Meta-Analysis of Randomized Trials Acupuncture in Post stroke Rehabilitation In conclusion, the study demonstrates that Ac is likely effective for improving post stroke rehabilitation. Given concerns about study quality, we are reticent to strongly endorse Ac from this review, but argue that there is compelling evidence for a large and well-conducted randomized clinical trial to confirm our findings and support implementation within clinical practice for post stroke rehabilitation. From”Acupuncture in Poststrokerehailitation”, Ping Wu, MD, MSc; Edward, MSc, PhD; David Moher, MSc, PdD; DugaldSeely, ND, MSc. Stroke Published Online, Feb 18, 2010

20. The Treatment of Bell’s Palsy with Acupuncture and Chinese Herbs Bell’s Palsy or idiopathic facial paralysis is a disease caused by inflammation of unknown origin effecting the facial nerve resulting in acute paralysis of one side of the face. Approximately 2 to 3 people per 10,000 and may resolve by itself within a few months with severe cases taking up to one year. Unfortunately, up to 10% of patients will experience some degree of permanent paralysis. Conventional treatment includes corticosteroids, antiviral agents, massage, painkillers, botulinum toxin and surgery. From”The Treatment of Bell’s Palsy with Acupuncture and Chinese Herbs”, Grey River .

21. The Treatment of Bell’s Palsy with Acupuncture and Chinese Herbs From”The Treatment of Bell’s Palsy with Acupuncture and Chinese Herbs”, Grey River .

22. Herbal Formulation used: Initial: Qin Jiao, Fang Feng, Chuan Xiong, Pu Gong Ying, Dang Gui, Xi Xin, BaiShao, Di Long, Fu Ling, Gan Cao. Chi Shao, Huang Qin, BaiZhi, and Bai Zhu were used to modify the fomula Acupuncture points used: Stomach 4 (thread toward stomach 6), stomach 6 (perpendicular), stomach 7 (perpendicular), Bitong, Large Intestine 20 (toward Bitong), Small Intestine 18 (perpendicular), Stomach 2 (thread toward Large Intestine 20), Gall Bladder 14 (thread to Yu Yao), San Jiao 17 (toward opposite ear 0.5-1 cun), stomach 3 (perpendicular), Du 26 (thread toward Large Intestin 19), Du 20 (directed forward), Bladder 2 (thread toward Yu Yao), Stomach 7 (perpendicular and directed medial), Gall Bladder 20 (perpendicular) Yintang (M-HN-18). Significant rubor or sweating was achieved on the affected side every treatment. Distal point: Stomach 36, Gall Bladder 34, Liver 3, Large Intestine 4, Lung 7, San Jiao 5, Spleen 6. Typical herbs applied as paste: Chuan Xiong, Rou Gui, Gan Jiang, Ai Ye, Mu Dan Pi Hand held moxa stick used above face as well as electronic stimulation and strong cupping of Du 14. The Treatment of Bell’s Palsy with Acupuncture and Chinese Herbs From”The Treatment of Bell’s Palsy with Acupuncture and Chinese Herbs”, Grey River .

23. Background:Bell’s palsy or idiopathic facial palsy is a unilateral, lower motor neuron facial paralysis, which is acute in onset. It is the most common disorder affecting the facial nerves and results in weakness or paralysis on one side of the face. The paralysis causes distortion of facial features and interferes with normal functions, such as closing the eye and eating. Adour et al. (Adour 1978) advocated making a diagnosis based on the history and clinical symptoms including the presence of taste and the absence of hearing problems. May and Klein (May 1991) recommended excluding other diagnostic entities based on a defined workup and a lengthy differential diagnosis. Studies of incidence have been carried out in the United States and in Japan (Brandenburg 1993; Katusic 1986; Yanagihara 1988). All relied on retrospective examination of hospital and clinic records to ascertain cases and are likely to have underestimated the frequency of mild cases that remained undiagnosed or were treated in primary care. Crude incidence rates in these studies were similar: in Rochester, Minnesota, USA, annual incidence was 25 per 100, 000 population; in Laredo, Texas, USA, 23.5 per 100, 000 in men and 32.7 per 100, 000 in women; and in the Ehime prefecture, Japan, 30 per 100, 000 population. Rates for men and women were similar in Rochester and in the Ehime prefecture. The peak incidence lies between 20 and 40 years of age. Both sides of the face are affected equally (Martyn 1997; Prescott 1988). Acupuncture for Bell’s Palsy From”Acupuncture for Bell’s Palsy”, He L, Zhou M, Zhou D, Wu B, Li N, Kong SY, Zhang D, Li Q, Yang J, Zhang X. The Cochrane Collaboration, The Cochrane Library, 2009 Issue 1.

24. Acupuncture for Bell’s Palsy From”Acupuncture for Bell’s Palsy”, He L, Zhou M, Zhou D, Wu B, Li N, Kong SY, Zhang D, Li Q, Yang J, Zhang X. The Cochrane Collaboration, The Cochrane Library, 2009 Issue 1.

25. Acupuncture for Bell’s Palsy From”Acupuncture for Bell’s Palsy”, He L, Zhou M, Zhou D, Wu B, Li N, Kong SY, Zhang D, Li Q, Yang J, Zhang X. The Cochrane Collaboration, The Cochrane Library, 2009 Issue 1.

26. Acupuncture for Bell’s Palsy From”Acupuncture for Bell’s Palsy”, He L, Zhou M, Zhou D, Wu B, Li N, Kong SY, Zhang D, Li Q, Yang J, Zhang X. The Cochrane Collaboration, The Cochrane Library, 2009 Issue 1.

27. Acupuncture for Bell’s Palsy From”Acupuncture for Bell’s Palsy”, He L, Zhou M, Zhou D, Wu B, Li N, Kong SY, Zhang D, Li Q, Yang J, Zhang X. The Cochrane Collaboration, The Cochrane Library, 2009 Issue 1.

28. Acupuncture for Bell’s Palsy From”Acupuncture for Bell’s Palsy”, He L, Zhou M, Zhou D, Wu B, Li N, Kong SY, Zhang D, Li Q, Yang J, Zhang X. The Cochrane Collaboration, The Cochrane Library, 2009 Issue 1.

29. Electro-acupuncture: An Introduction and Its Use for Peripheral Facial Paralysis From”Electroacupuncture: An introduction and its use for peripheral facial paralysis”, by David F. Major. Journal of Chinese Medicine, Number 84, June 2007

30. Electro-acupuncture: An Introduction and Its Use for Peripheral Facial Paralysis From”Electroacupuncture: An introduction and its use for peripheral facial paralysis”, by David F. Major. Journal of Chinese Medicine, Number 84, June 2007

31. Electro-acupuncture: An Introduction and Its Use for Peripheral Facial Paralysis From”Electroacupuncture: An introduction and its use for peripheral facial paralysis”, by David F. Major. Journal of Chinese Medicine, Number 84, June 2007

32. Electro-acupuncture: An Introduction and Its Use for Peripheral Facial Paralysis From”Electroacupuncture: An introduction and its use for peripheral facial paralysis”, by David F. Major. Journal of Chinese Medicine, Number 84, June 2007

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