Results tagged “Yemeng Chen” from Acupuncture & TCM Blog

Yemeng Chen, O.M.D. (China), Dipl. OM (NCCAOM), L.Ac.
President, New York College of Traditional Chinese Medicine
155 First Street
Mineola, NY 11501
 
In TCM, brain disorders include various neurological diseases and psychiatric disorders as well as some psychosomatic diseases. Anxiety, depression, stroke, and Parkinson's disease, even Alzheimer's disease, are all related to functional or organic variation in the brain.
 
In contemporary society, the morbidity rate of brain disorders has been increasing due to stressful social circumstances, poor dietary habits and sedentary lifestyles. It is estimated that 50 million Americans are affected each year by disorders and disabilities that involve the brain. It is also estimated that treatment, rehabilitation and related costs of these kinds of disorders and disabilities represent a substantial economic burden of $305 billion annually.
 
As a result, different approaches to research on brain disorders are developing. Acupuncture, one of the most important aspects of alternative medicine, is an approach under investigation. Its effectiveness can be conformed by numerous references in ancient literature, as well as modern clinical trials, and ongoing laboratory research.
 
Acupuncture from Past to Present
 
In a history that spans thousands of years, acupuncture therapy is indicated numerous times in the treatment of brain disorders. In ancient times, practitioners didn't have the same definition of brain disorders that are used today. But acupuncture was used to treated related ailments such as headache, seizures, maniac ad depressive psychosis, hemiplegia and facial paralysis all are described in the famous, Canon of Medicine (Nei Jing), one of the earliest medical books in China. 
 
The meridian theory is the foundation of clinical acupuncture practice. Acupuncture treats brain disorders by meridian circulation and regulation of the body's constitution. In the Canon of Medicine, the meridian theory is applied to the physical relationships between meridians and the brain. According to the Meridian chart, which maps the body's energetic network, the Bladder Meridian goes up to the vertex and connects to the brain, and the Governor Vessel also ascends to the brain.
 
In the last 50 years, acupuncture has paid more attention to the treatment of brain disorders. The invention of electro-acupuncture in the 140's increased the potential. Electro-acupuncture can be a substitute for needle manipulation and is especially good for acupuncture analgesia. Electro-acupuncture is also more effective in treating paralysis than classic acupuncture. Scalp acupuncture, requiring anatomical knowledge of the cerebral cortex, was developed from 1960 to 1970s. Scalp acupuncture enhances the clinical efficacy in the treatment of cerebral diseases such as post-stroke hemiplegia and Parkinson's disease. Some acupuncturists report that auricular acupuncture can be applied to treat attention deficit disorders. All these micro-acupuncture systems are prevalent in current clinical practice.
 
Acupuncture & Psychological Disorders
 
Some physical symptoms in the body due to psychological factors are called psychosomatic disorders. Traditional Chinese medicine emphasizes that emotional factors are important physical factors when identifying pathogens in causing internal organ disharmony. TCM treatment strategies understand that balancing the energetic flow of the body enhance emotional adjustment as well. Clinical information supports the fact that many diseases with psychosomatic components, such as hypertension, arrhythmia, chronic prostatitis, male erection dysfunction, and PMS, are effective indications for acupuncture treatment.
 
In September 1998, a new study from the University of Arizona, by John J.B. Allen, published in Psychological Science, the Journal of the American Psychological Society, indicates the efficacy of acupuncture as the alternative treatment for major depression in 38 women. Specific treatment involved acupuncture for symptoms of depression. Following treatments specifically designated to address depression, 64% of the women experienced full remission. A comparison of the acute effect of the three 8-week treatment conditions showed that patients receiving specific acupuncture treatments improved significantly more than those receiving the placebo-like nonspecific acupuncture treatment. The result suggests that acupuncture can provide significant symptom relief in depression, at rates comparable to those of psychotherapy or pharmacotherapy.
 
"Conventional treatment for depression such as psychotherapy and pharmacotherapy provide significant relief for approximately 50 - 70 percent of those who complete treatment. Unfortunately, about a third of people seeking treatment prematurely, citing factors such as dissatisfaction with their current treatment of intolerable side effects. So taking all of this into account, over half of all depressed persons who enter treatment fail to recover." Said Allen. "These statistics suggest that alternative treatment may be welcomed by those suffering from depression. In fact a recent survey among people who reported that they suffered from depression, seeking alternative treatments was more common than seeking the services of a traditional provider alone."
 
Acupuncture & the Brain
 
The blood-brain barrier is the body's own structure for self-protection, preventing all non-liposoluble chemical drugs from passing through. But this protective barrier also causes some difficulty in the treatment of brain disorders, since non-liposoluble drugs cannot directly enter the brain tissue to deliver a therapeutic effect. Acupuncture effectively bypassed this problem. After needling some specific points of the body surface, called acupoints, the stimulation is afferent from peripheral nerves to the spinal cord, traveling up then finally reaching the cerebral cortex. And because acupuncture has no side effect such as chemical toxicity or addiction, it offers superiority in treating many brain disorders.
 
In conventional medicine, there are few effective methods for treating certain cerebral diseases such as infantile atelencephalia, pseudo bulbar paralysis, and seizure attack. Acupuncture can significantly relieve and improve some symptoms in these difficult cases. Experimental research indicates the after cerebral infarction acupuncture has an obvious effect in increasing the blood oxygen supply and brain blood flow in the surviving brain tissue, and increase the lateral circulation function so that surviving brain tissue have more compensatory ability. The other mechanisms of acupuncture in treating post-stroke hemiplegia include dilating vessels, improving vascular viscosity, and enhancing the sensory and motor function of the extremities.
 
Acupuncture, and especially electro-acupuncture, has been conformed to have anti-convulsive effect. Acupuncture has an instant influential effect on brain waves, normalizing brain waves in EEG reading and minimizing or seizing epileptic electricity during an episode. It can therefore treat seizure attacks by controlling the symptoms and extending the attack intervals.
 
Recent research has discovered that acupuncture could activate the reticular structure and cerebral cortex functions and regulate and harmonize their interrelationships. It can keep the cerebral cortex in a waking state and decrease over-activation. In this way, acupuncture an effectively address different psychological problems.
 
Acupuncture has obvious effects n the improvement of the cerebral cortex and certain nerve center functions, resulting in significant therapeutic effect in treating some psychosomatic diseases. For example, during acupuncture treatments for hypertension, it was found that vascular peripheral resistance decreased and brain blood flow improved. These therapeutic effects for maintaining normal blood pressure are most likely related to acupuncture causing the endogenous morphine-like substance to release and inhibit the neuron activity in the ventral lateral bulbar area.
 
Acupuncture & Stroke
 
Stroke, also called brain attack, is a cardiovascular disease that affects the blood vessel supplying blood to the brain. Acupuncture is effective in the treatment of post-stroke hemiplegia. Several different clinical trials have revealed that it is far more effective that the spontaneous recovery rate. It is very important to differentiate the hemorrhagic and ischemic types of stroke. It is recommended that in stroke due to cerebral hemorrhage the patient should avoid acupuncture within two to three weeks of the initial attack. On the other hand, in stroke due to cerebral infarction, the patient should apply acupuncture treatment as soon as possible. Clinical experience shows that acupuncture has obvious effects for post-stroke hemiplegia within three months.
 
The author believes that the following principles benefit the early recovery of paralysis: combined acupoint selection based on the differentiation diagnosis by traditional Chinese medicine and local symptoms, combined therapies of body acupuncture and scalp acupuncture, and combined methods of electro-acupuncture and needle manipulation. In a controlled 108-patient case study, the total effective rate was 83.3% with his method.
 
Acupuncture & Senile Dementia
 
Senile dementia, a disease found only in the aged, is characterized by impaired memory and intellectual decline. The two main types are Alzheimer's disease, due to brain degeneration, and multi-infarct dementia. Unfortunately, patients suffering from severe dementia place a heavy burden on their families and community. In the author's pilot study on acupuncture treatment for these difficult cases, the trial showed, in 38 cases of senile dementia, the acupuncture therapy is effective for multi-infarct dementia; the rate of success being 42.85% and of improvement 42.86%. Three months later, the major rate of intellectual decline varied from 39.46% to 27.52%. Although the intellectual scale of the patient in successful cases is still lower than that of a normal group of the same age, most showed significant improvement of symptoms of body disorders, dysgnosia, and mental and emotional abnormalities. This research was repeated and conformed by other scholars in this are in subsequent years.
 
(This article was originally published in Traditional Chinese Medicine World, Fall Volume, p. 9, 1999)  
 
 

NYCTCM President Yemeng Chen was invited to make a speech in the 5th Pang Dingyuan's International Integrative Medicine Symposium sponsored by the University of Hong Kong, School of Chinese Medicine in December 2008.

The speech in Hong Kong was about the Clinical Research on Acupuncture Applied to Treat Vascular Dementia.

Here is a link to the Powerpoint presentation, in Chinese, of Dr. Chen's speech on Clinical Research on Acupuncture Applied to Treat Vascular Dementia.

vd-chenyemeng-forwebsite.ppt

Abstract: Combining: Combining acupuncture with acupoint-injection of aceglutamidi has been used in treating 38 cases of senile dementia. The experiment showed that the therapy is effective for the cases of multi-infarct dementia, the rate of success being 42.82% and of improvement 42.86%. The rating was based on the revised Hasegawa Dementia Scale and the Functional Activity Questionnaire. In addition, it has been observed that the component of high density lipid-cholesterol increased (HDL-C) significantly after treatment.

Kew Words: Acupuncture, acupoint-injection, aceglutamidi, senile dementia, multi-infarct dementia, high density lipid-cholesterol (HDL-C)

Senile dementia, its main types being Alzheimer's disease (senile dementia of Alzheimer's type, SDAT) and multi-infarct dementia (MID), is a special disease found only in the aged. Ii is characterized by impaired memory and intellectual decline. Being unable to take care of themselves, patients suffering from severe dementia are a heavy burden to the family and community. With the increased proportion of aged people among the populace, the morbidity of senile dementia has also increased. Therefore the disease has been listed as one of the most important items in the research of geriatrics. Beginning from 1988, we tried to combine acupuncture with acupoint-injection of aceglutamidi to treat 38 cases of senile dementia. Having analyzed the clinical data, we found the multi-infarct dementia is an effective indication of acupuncture. The observation is as the follows.

Clinical Data

1. General data
All the 38 cases (23 male and 15 female) were treated in the out-patient department. They were between 55 and 83 years old, their average age being 68±7, and their case history ranged from one month to ten years, averaging 26±23 months.

32 cases were examined by Computerized Tomography (CT) or Magnetic Reasonable Imaging (MRI) which showed brain atrophy in 16 of them, multi-infarction (located respectively in the cortex, subcortical white matter and basal ganglia) in 11 and local small infarction (localized respectively in the right frontal, vertex lobe and inner capsule) in 5. Among the remaining 6 who were not scanned by CT or MRI, 3 had a history of stroke.

2. The criteria for diagnosis
The criteria (1) set in the third edition of The Diagnosis and Statistical Manual (DSM-III) of the American Psychiatric Association was used in the research.

A. A deterioration of previously acquired intellectual abilities of sufficient severity to interfere with social or occupational functioning.
B. Memory impairment.
C. At least two of the following: impairment of abstract thinking; other cognitive deficits such as impaired calculation, aparaxia, or anomic aphasia; impairment in judgment; impairment in impulse control; personality change.
D. Evidence from physical exam, laboratory tests, or history of a specific organic factor that is judged to be etiologically related to the disturbance.

3. Criteria for differentiating MID from SDAT
The Hachinski Ischemic Score (IS) (2) was applied that is based on such clinical features as a sudden onset, a stepwise deterioration, a fluctuated deterioration course, a confusion of consciousness at night, a relative conservation of personality, a depressive state, a body disorder, a fragile thymia, a case history of hypertension or stroke, presence of arteriosclerosis and focal neurologic symptoms and signs. If the score is less that 4, the diagnosis meets SDAT; and if the score is more than 7, the diagnosis meets MID. Hence, there were 17 cases of SDAT and 21 cases of MID.

4. Criteria for the grading of dementia
Slight: Obvious waning of memory; HDS ranging from 21.5 to 29.5; presence of brain asthenia symptoms. (Among the 38 under observation, 5 were graded as SDAT and 9, MID)

Medium: Complete dementia with social activity relatively retained and intelligence score ranging from 10.5 to 21.4. (There were 16 cases of medium dementia, 8 cases of SDAT and 8 MID)

Severe: Complete dementia with social activity function badly affected and intelligence score ranging from 0 to 10.4. (There were 8 cases of severe dementia, 4 cases being SDAT and 4 MID)

Materials & Methods
The acupoints chosen for needling were mainly in the Governor Vessel, such as Baihui (GV 20), Naohu (GV 17), Shuigou (GV 26), etc., and aceglutamidi was injected into such tonic points as Dazhui (GV 14), Ganshu (BL 18), Shenshu (BL 23), Zusanli (ST 36), etc.

As a rule, acupoint-injection came after acupuncture treatment. The acupuncture needles were retained in the chosen acupoints for twenty minutes. For injection, only one ml of aceglutamidi was needed. The patients were treated every other day, each course being fifteen sessions. And the results were observed after three courses.

Results of Treatment

1. Criteria for evaluation
Excellent: The HDS score increased by two grades or approached normal and the FAQ also approached normal on the whole.

Effective: The HDS score increased by one grade, and the FAQ increased to a considerable degree.

Improved: The HDS or the FAQ score improved to a certain degree and a general improvement was observed about the symptoms.

Ineffective: No improvement was seen in either the HDS or the FAQ score.

2. Effects of treatment
In the SDAT group, improvement was seen in 7 cases (35.29%), and 10 cases showed no response (64.71%), the rate of improvement being 35.29%.

In the MID group, treatment proved excellent in 2 cases (9.52%), effective in 7 cases (33.3%); 9 cases showed improved (42.86%) and 3 cases no response (14.29%), the total effective rate being 42.82%.

3. Observation before and after treatment
1) The Hasegawa Dementia Scale (the full mark being 31.5)
20 elderly men and women with normal intelligence and mental functions were chosen as the control group, their average age being 69±5. The average age of the SDAT group was 67±7 and that of the MID group 69±6.

Table 1: Changes in the HDS Score
                               Control Group                   SDAT Group                 MID Group
Before Treatment        30.1±1.82                          14.71±8.32                 19.07±6.99
After Treatment                                                   15.47±9.05                  22.83±6.59

Marked difference existed in the HDS score between the control group and the dementia groups before treatment. Obviously in the SDAT group there was no meaningful difference before and after treatment (P>0.05) whereas the HDS score of the patients in the MID group went up greatly after treatment (P<0.001).

2) The Functional Activity Questionnaire (Score ranging from 0 to 30, zero being normal)
Significant difference existed between the control group and the dementia groups before treatment. In the SDAT group there was no meaningful difference before and after treatment (P>0.05) whereas in the MID group the FAQ score changed significantly after treatment (P<0.01).













Discussion

1. About dementia
Dementia is characterized by intellectual decline. People over sixty years of age who are afflicted with senile dementia show an overall decline of their mental function, including a severe decline of cognition, memory, abstract and initiative thinking due to organic disorder in the brain or constant metabolism damage. As a result of the growing portion of the aged people in world population, the number of senile dementia cases has increased considerably. Statistics show that the morbidity of senile dementia in China accounts for 2.81% of the people who are over sixty, and the rate tends to increase.

(5) Clinical experience has revealed that dementia can be caused by different factors. Among dementia cases, the most frequently encountered are Alzheimer's diseases (SDAT) and cerebrovascular dementia, i.e., multi-infarct dementia (MID). Diagnosis show that these two accounts for 80 - 90% of dementia cases. According to WHO statistics, SDAT accounts for 50 - 60% and MID accounts for 15% and the combination of SDAT and MID accounts for 10%.

(6) In China the proportion of MID is overwhelming.

Usually SDAT afflicts the patients in the last stage of his life, its symptoms being slow, continuous intellectual decline and personality change, and an overall disturbance in judgment, sense, reorganization, memory and emotion. Brain CT scan shows enlargement of brain ventricles, wide gyrus and wide brain cannel and atrophy in the cerebral cortex. MID bears such evidence as body arteriosclerosis, a history of recurrent transient ischemic attack (TIA) or ill-treated hypertension, severe moral disturbances. The disease often accompanied by focal neurologic signs can be severe or slight at different time. And the brain CT scan shows multiple cerebral infarctions with small foci.

Hachinski Ischemic Score is helpful for distinguishing the two main senile dementia cases clinically.

2. About the acupuncture treatment for dementia
In traditional Chinese medicine, the terms "Jian Wang (amnesia)" and "Dian Zheng (depressive psychosis syndrome)" have appeared in different volumes wherein the symptoms described are similar to those of dementia cases. The records of Emperor's Cannon of Medicine indicated that the brain is a sea of marrow and deficiency of the brain leads to vertigo and dizziness. Li Shizhen （1518- 1593）of the Ming Dynasty clearly explained that the human brain is the place of the mind. In the Qing Dynasty, Wang Qingren （1768- 1831）in the book Revision of Medical Classics advanced the theory that memory impairment in the aged is due to deficiency of brain marrow. According to traditional Chinese medicine, the etiology of the disease is attributed to deficiency of kidney-essence in the aged, as a result of which the kidney-essence and kidney Qi cannot go upward to nourish the brain. In the mean time, owing to the phlegm stagnation and blood stasis, blocks in the brain are formed and in due course, spiritual disturbance and other pathological symptoms will follow.

According to the traditional meridian theory, the Governor Vessel goes upward to vertex and enters the brain. So the acupoints of Baihui (GV 20) and Shuigou (GV 26) should be selected. According to traditional etiology, Ganshu (BL 18), Shenshu (BL 23) and Zusanli (ST 36) should be selected to invigorate the liver, kidney and to tonify the vital energy. Omura reported that acupuncture improves not only local circulation but also brain circulation. (7, 8) Another experiments show that acupuncture on certain specific acupoints in the head region of the Governor Vessel may activate the cerebral cortex function. Acegulutamidi solution injected into such acupoints can go through the blood-brain barrier, improve the cerebral tissue metabolism as well as brain function, and maintain its good excitable function.

3. Summary of this clinical trial
Hitherto, there have been no reports at home and abroad concerning treating senile dementia by acupuncture combined acupoint-injection. However, it has been reported that application of tabellae prytioli to treat SDAT has scored an improvement rate of 27% and the application of amantadine to treat MID has scored and efficacy rate of 43%. (9, 10)

In this clinical trial, the prevalent intelligence scales were adopted together with brain CT scan or MRI to grasp the diagnosis. After three month's acupuncture treatment, it was found that the improvement rate of the SDAT was 35.29%. In the MID group the efficacy rate was 42.85%. And here lies the significant difference between the two groups. In the MID group, it was discovered that HDL-C component had been raised obviously with acupoint-injection in treating multi-infarct dementia is convincing. Hence, multi-infarct dementia can be listed as an effective indication of acupuncture.

(The article was originally published in Acupuncture & Electro-Therapeutics Research, International Journal, Vol.17, pp. 61 - 73, 1992)

(3 PDA Points Pending NCCAOM Approval)

Speaker: Yemeng Chen, L.Ac., FICAE

Day: 09/28/08, 2:00 PM -5:00 PM

Location: NYCTCM, Room 106 155 First Street, Mineola, NY 11501

Course Description:

In our car-oriented society, whiplash injury cases are commonly seen in acupuncture practice. The lecture will introduce the viewpoint of whiplash injury, pattern differentiation and especially analysis of Musculo-Tendino Meridian theory applied in whiplash injury cases. Special acupuncture needle techniques corresponding to the musculo-tendino meridian system and points selection related to different complications will be introduced as well as effective Chinese herbal formulas and Tui Na manipulations. Demonstration included.

Read Dr. Chen's paper on Treating Whiplash Injuries with Acupuncture.

About the Speaker:

Yemeng Chen, L.Ac., FICAE, is the President of NYCTCM and the Vice-Chair of the New York State Board for Acupuncture. He also serves as an At-Large Member of Executive Committee and Chair of the Herbal Committee of the Council of Colleges of Acupuncture & Oriental Medicine. He has 23 years of experience as a practitioner, researcher and educator in Chinese medicine with numerous publications. 

Registration:

3 CEUs, $60 ($75 after 09/18), $45 for students ($60 after 09/18). Please download the registration form and mail it with your payment to

NYCTCM
ATT: Dr. Xu, Program Coordinator
Continuing Education Program
155 First Street
Mineola, NY 11501


Telephone: (516) 739-1545

email: Email CEU

Registration Form:
CEU_082308.pdf

Yemeng Chen, L. Ac., FICAE, President, New York College of Traditional Chinese Medicine

In our car-oriented society, whiplash injury cases are commonly seen in acupuncture practice. These patients typically have long-term physical and subjective symptoms for which acupuncture treatment is a useful modality.

1. Factors

According to 1994 estimates, upwards of 1 million people sustain whiplash-type injuries per year in United States. Of more than 11 million motor vehicle accidents that year, 2.6 million involved rear-end collisions in. Women (especially 20- to 40-year age group) have persistent neck pain more often than men, by a ratio of 7:3. (1)

Whiplash injury refers to neck injury, resulting from hyperextension followed by flexion that occurs when an occupant of a motor vehicle is hit from behind by another vehicle. Other terms have been used such as cervical sprain, cervical myofacial pain Syndrome, acceleration-deceleration injury, hyperextension injury and soft tissue cervical hyperextension injury. (2)

One study (3) showed the ten most-reported symptoms with their estimated prevalence: neck pain (97%), headache (97%), TMJ (82%), Shoulder pain (65%), anxiety (55%), back pain (42%), depression (41%), visual symptoms (blurred vision) (35%), and dizziness (23%). The clinical features of whiplash injury include myofascial injury (cervical strain, muscle tears, and/or rupture of ligaments), cervical disc herniation, cervical spine fracture and cervical facet-joint injury. Acupuncture has demonstrated a significant therapeutic effect on myofascial injuries.

Long-term, positive outcomes of whiplash injury are elusive. One clinical trial (4) showed the percentage of patients with residual pain: 44% had pain at three months, 30% at six months, 24% at twelve months, and 18% at two years. But only 4% of the patients were considered disabled at two years. If the head was inclined or rotated at the time of collision, patients were more likely to have pain at a two-year follow-up. A history of pre-traumatic headache predicted a worse outcome. Patients with long-term symptoms were more likely to have radicular symptoms, anxiety, sleep disturbance, and blurred vision.

2. Therapeutic Effect of Acupuncture

Although whiplash injury patients are commonly seen in acupuncture clinics, only a few clinical trials and research projects has been conducted. Greenwood, et al, reported that 25 patients with whiplash injury, most of whom had twelve treatments at twice weekly intervals. Improvement was noted in 84% of patients. Observed phenomena included myoclonic jerking, emotional releases and regression. (5) Rabl V, et al, had a trial with 153 patients suffering from pain, edematous conditions, and impaired movement following traumas sustained in accidents who were treated or "after-treated" with acupuncture. With a standardized acupuncture program, the improvement was significant in all nine groups Acupuncture also proved itself to be an effective form of therapy for after-treatment. (6) Ayuzawa S, et al, reported that the Bi-Digital O-Ring test successfully used in the diagnosis and treatment for patients with pain after whiplash injury. (7) Hertz H, et al, treated 30 whiplash injury patients with auricular acupuncture, demonstrating its effectiveness as a form of therapy for treatment of accident patients with whiplash. (8) Fattori B, et al, had a trial of 15 patients with a control group of balance disorders following whiplash injury, and observed a significant difference between the two groups regarding the reduction of the CER (closed eyes with retroflexed head) length of the statokenisigram. (9) Recently, Fattori, et al, (10) had a further study with 27 patients with a control group of 25 patients, who were treated with a non-steroidal anti-inflammatory drug and myorelaxation or with physiotherapy only.

They evaluated by computerized static posturography the postural changes after acupuncture treatment. Acupuncture was performed on bilaterally Tianzhu (BL 10) and Fengchi (GB 20), twirled manually for 20 seconds. The study revealed a considerable difference between the two groups as regards the reduction of the CE (close eye) and CER length of the statokinesigram just before each session of acupuncture; the frequency oscillation on the sagittal plane in CER was reduced in the study group, with a progressive increase of its values in the control group. The high percentage of positive results in whiplash injury patients lead them to advocate acupuncture for balance disorders due to whiplash injury.

From 1998 - 2000, I had a retrospective observation on the effectiveness of acupuncture treatment in 75 whiplash injury cases with acupuncture treatment. This group includes 46 females and 29 males, age 21 - 65 years old, averaging 42 years old. Among these patients, there were 23 Caucasians, 15 African-Americans, 30 Hispanic and 7 Asians. The length of time after accident ranged from 3 weeks to 8 years. 25 patients were confirmed by MRI as cervical herniated discs and 4 patients had undergone cervical surgery. After three months of treatment, there were 18 patients reported significant improvement (disappearance of pain, general feeling of wellness, significant relief of symptoms like headache, depression and fatigue), 47 reported improvement (pain obviously diminished but still having occasional recurrent attack, general symptoms improved) and 10 cases reported no improvement ( no obvious change before and after treatment), the rate of improvement wass 86.7%. (11)

3. Classifying Whiplash Injury according to Traditional Chinese Medicine Theory

Whiplash injuries are related to the symptom of cervical strain and sprain as described in the ancient literature. It is also related to the following tendon problems like "Jing Wai (tendon deviated)", "Jing Zhou (tendon in abnormal position)" and "Jing Jie (tendon knotted)". Considered in the light of the theory of musculo-tendino channels lesions, it was divided as three types: Yangming Type (Unable to turn the neck), Shaoyang type (Uncomfortably holding the neck with pulling sensation when turning the neck) and Taiyang type (tightness and spasm of the muscles in the neck) which is very important for choosing acupoints during the treatment.

According to TCM pathogenesis analysis, during the strain and sprain, Qi is first shocked, then moves fast, causing congestion and stagnation (Qi Stagnation). And when Qi stagnates, blood circulation will be impeded and blood will coagulate (Blood Stasis).
When Qi and blood are impaired, body fluid is also involved so the body fluid metabolism becomes disordered. Gradually, the body produces Turbid Phlegm which then blocks the meridian circulation. This is why the patient complains of pain and numbness of the neck and extremities.

In the other circumstance after sprain and injury, blood clots are in retention in the body which also impedes the blood circulation. Gradually, it will impair the liver. Sprain lasting for a long time also impairs the kidney, leading to Liver and kidney Insufficiency that will cause neck soreness, weakness, blurred vision and vertigo.
Severe soft tissue injury causes Qi and blood stagnation. The disarrangement spreads from exterior to interior so both Qi and blood impaired. Gradually, the Qi and Blood are both Deficiency situation. So the symptoms such as fatigue, tiredness and lingering pain and soreness developed.

4. Treatment Strategies for Whiplash Injury

In my personal experiences, the following principles of acupoint selection enhance the therapeutic effect of treatment for whiplash injuries.
1) Acupoint selection considering of the relationship of meridian system, especially the musculo- tendino meridian system
2) Acupoint selection considering of the pattern differentiation
3) Acupoint selection considering of the local symptoms
4) Acupoint selection combined with the distal and local points
5) Acupoint selection combined with body acupuncture and auricular acupuncture
6) Acupuncture combined with passive movement and Tui Na therapy

What follows is an elaboration of these strategies. I discuss Strategies 1 - 3 in detail, including within each section recommendations for Strategies 4 - 6.

1) Acupuncture treatment related to musculo-tendino meridian system

This method is especially useful for patients who complain of limited motion during the acute stage. If the patient is unable to turn the neck aside, it is counted as the Yangming Type lesion so Luozhen (Ex.) should be selected. If the patient is unable to bend the neck to the side, is uncomfortable holding the neck, or experiences a pulling sensation when turning the neck, it is counted as the Shaoyang type lesion so Waiguan (SJ 5) should be selected. And if the patient is unable to extend and flex the head and feels tightness and spasm of the muscles in the neck, it is counted as the Taiyang type lesion so Houxi (SI 3) should be selected. It is usually important to ask patient to cooperate with passive neck motion while stimulating these points.

2) Acupuncture treatment related to differentiation of patterns

Acute Stage

a. Qi Stagnation Type

Manifestations: Moving pain around neck, shoulder and upper back; soreness and heaviness in the upper extremities, aggravated from cold and alleviated from the heat; neck rigidity and muscle in tension; limited range of motion; feelings of by anxiety and panic. Patients usually present a slight purple tongue with wiry pulse.
Acupoints selection: Corresponding cervical Jiaji (especially on C 5-6 and C 6-7 Jiaji because of whiplash pivoting at the C5 to C6 level during accident), Fengchi (GB 20), Tianzhu (BL 10), Bingfeng (SI 12), Jianwaishu (SI 14), Jianzhongshu (SI 15), Hegu (LI 4), Lieque (LU 7). After needle insertion with Qi arrival, hold an ignited moxa stick toward needle's tail for 1 minute each or apply the TDP lamp. Add Yingtang (Ex.) and Shenmen (HT 7) for anxiety and panic, and Wangu (GB 12) for dizziness.

b. Blood Stasis Type

Manifestations: Stabbing and burning pain in the neck and upper extremity; pain in a fixed location, aggravated at night, intense pain upon pressure; numbness or tingling sensation in the fingers; headache and vertigo. Patients usually present a dark and purple tongue with blue ecchymosis at the side, with a wiry or choppy pulse.

Acupoints selection: Corresponding Cervical Jiaji (especially C 5-6, C 6-7 Jiaji), Fengchi (GB 20), Tianzhu (BL 10), Dazhui (GV 14), Jianjin (GB 21), Geshu (BL 17), Hegu (LI 4), Houxi (SI 3), Baxie (Ex.). For the patient with severe pain, use Tui Na manipulation for few minutes in advance or apply correspondent auricular points first. After acupuncture treatment, we can also apply seven-star needles plus cupping in the local area.

Chronic Stage

a. Turbid Phlegm Blockage Type

Manifestations: History of whiplash injury, nape and neck stiffness and pulling sensation, accompanied by upper extremity heaviness; numbness in the finger tips; limited range of motion in the neck, aggravated with humidity and raining days, dizziness and nausea. Patients usually present a thick and sticky coating on the tongue with a slippery pulse.

Acupoint selections: Corresponding cervical Jiaji, Jianyu (LI 15), Shousanli (LI 10), Hegu (LI 4), Neiguan (PC 6), Zhongwan (CV 12), Pishu (BL 20), Sanjiaoshu (BL 22), Fenglong (ST 40), Sanyijiao (SP 6) plus local moving cupping after needling treatment.

b. Liver & Kidney Insufficiency Type

Manifestations: History of whiplash injury; soreness and weakness in the neck; tinnitus, vertigo, blurring vision; hot flashing, dry throat, insomnia, dream-disturbed sleeping, irritability, inability to sit or stand for long time; soreness in the waist and in the knee joint; finger numbness; and spasm and tightness in the extremities. Patients usually present a small tongue that is red or crimson proper, less coating; and a wiry and thready or wiry and rapid pulse.

Acupoints selection: Corresponding cervical Jiaji (Ex.), Jianjin (GB 21), Tianzong (SI 11), Sidu (SJ 9), Zhigou (SJ 6), Baxie (Ex.), Geshu (BL 17), Ganshu (BL 18), Shenshu (BL 23), Shenmai (BL 62), Xuanzhong (GB 39), Sanyinjiao (SP 6). Add Sishencong (Ex.) for vertigo and Yanglingquan (GB 34) for spasm and tightness of extremities.

c. Qi & Blood Deficiency Type

Manifestations: History of whiplash injury; soreness and achiness in the neck region, lingering for long time, accompanied by tiredness and fatigue; pale complexion; soft or inaudible speech; poor appetite; loose stool. Patients usually present a pale tongue color with thin coating, and a deep and thready pulse.

Acupoints selection: Corresponding Cervical Jiaji (Ex.), Jianyu (LI 15), Jianliao (SJ 14), Quchi (LI 11), Shousanli (LI 10), Hegu (LI 4), Guanyuan (CV 4), Qihai (CV 6), Zusanli (ST 36), Sanyinjiao (SP 6) with moxibustion.

3) Acupuncture treatment related to local symptoms

a. Neck pain:

• Pain of the lateral part of vertebra: Tianzhu (BL 10)
• Pain due to the injuries of the supraspinous and interspnous ligament: Shuigou (GV 26) or Houxi (SI 3) (usually combined with patient passive movement while applying needle techniques on these points)
• Pain due to spasm of levator scapular: Jianwaishu (SI 15) and Quyuan (SI 13)
• Pain due to spasm of the trapezes: Jianjin (GB 21), Tianliao (SJ 15) and Xinshu (BL 15)
• Pain due to spasm of SCM: Fengchi (GB 20), Futu (LI 18) and Hegu (LI 4)
• Resistance to cervical extension/flexion: Dazhu (BL 11) and Houxi (SI 3)
• General stiffness: Fengchi (GB 20) and Jianwaishu (SI 15)

b. Shoulder pain:

• Referred pain in the scapular area: Jugu (LI 16)
• Pain in the anterior part: Jianyu (LI 15)
• Pain in the lateral part: Jianliao (SJ 14)
• Pain in the posterior part: Naoshu (SI 10)
• Difficulty in raising the arm: Binao (LI 14)

c. Headache:

• Occipital headache: Select Yuzhen (BL 9), Kunlun (BL 60)
• Temporal or migraine headache: Shuigu (GB 8), Zulinqi (GB 41)
• Frontal headache: Yangbai (GB 14), Hegu (LI 4)
d. TMJ: If a patient complains uncomforted or pain around the temporo-mandibular joint, Xiaguan (ST 7) and Ermen (SJ 21) should be added.

References

1. Goetz, Whiplash injuries, Textbook of Clinical Neurology, 1st Edition, W. B. Saunders Company, 1999, p.1052.
2. Rosen, Soft Tissue Cervical Pain, Emergency Medicine: Concepts and Clinical Practices, 4th Edition, Mosby Year Book, Inc., 1998, p.879
3. InjuryResources.com
4. Radanov BP, et al, Long-Term outcome after Whiplash Injury, A Tweo-year follow-up considering the features of Injury Mechanisms and Somatic, Radiologic, and Psychosocial Findings. Medicine, 1995, 74(5):281- 296
5. M.T. Greenwood, et al, Traditional Acupuncture Treatment for Whiplash Syndrome, American J. of Acup. Vol.16, No.4, 1988, P. 305 - 318
6. Rabl V, et al, he effect of Standardized Acupuncture Program in the Aftercare of Accident Patients, Unfallchirugie, 1983, 9(6):308
7. Ayuzawa S, et al, The Bi-Digital O-Ring Test Used in the Successful Diagnosis & Treatment of a Patient Suffering from Pain & Weakness of An Upper Extremety & Barre-Lieou Syndrome Appearing after Whiplash Injury, Acupunct Electrother Res 1997; 22(3-4):167
8. Hertz H, et al, Treatment of Whiplash Injuries of the Cervical Spine with Acupuncture, Aktuelle Traumatol 1983, 13(4):151
9. Fattori B, et al, Acupuncture Treatment for Balance Disorder following Whipalsh Injury, Acupuncture Electrother Res.,1996, 21(3-4):207
10. Fattori B, et al, Acupuncture Treatment of Whiplash Injury, Int Tinnitus, 2004:10 (2), p.156-160
11. Yemeng Chen, Whiplash Syndrome Treated with Acupuncture, Principles & Practice of Chinese Medicine in the West, Peoples Health Publishing House (China), pp 417- 432, 2003

(The original article was published in Meridian Times, The Journal of the Acupuncture Society of New York, Summer 2005/ Volume 14, Number 1, Page 20 - 23)