Difficult Cases and Good Doctoring

Good doctoring is good doctoring be it the practice of Chinese medicine, western medicine, or other medicines. It is hardest to be a good doctor with the most difficult cases, maintaining a balance of giving hope for better health while clearly informing the patient that the treatment may be unsuccessful.

Dr. Chan is faced with this dilemma often, in addition to his acupuncture and Chinese medicine skills, he is a compassionate doctor. He is a very famous doctor, in the time I've been with him, I've already seen patients with difficult diseases travel from far provinces such as jiangsu and guangzhou, as well as all parts Hunan. They stay with friends, relatives, in local hotels or the hospital, and for chronic neurological conditions, some even rent an apartment in Changsha to receive his acupuncture and herbal treatment. Even though he is very famous, Dr. Chan is very humble and modest which probably helps him with his patients.

The patients I've seen mostly complain of neurological problems (although one man travel from far in the North to see Dr. Chan about urinary difficulty and edema for an unknown cause). Two weeks ago, a young family from Jiangsu, brought their daughter to see Dr. Chan. She is one years old, and she was injured at birth by asphyxia. She is a very cute young girl, but developing very much behind normal functioning children and recently she developed a fever of unknown origin. Dr. Chan sees a lot of children with cerebral palsy and asphyxia, and this child was more severely injured than most. He told them that the improvement may be minimal due to the extent of their injuries, but they had faith in Dr. Chan and wanted him to perform the acupuncture. The treatment was similar to other cases of cerebral palsy and encephalitis, but adding Kid 1 to the quick needling of body points. They come in everyday to receive acupuncture, for a few days the fever went down, but it randomly returns.

Another difficult case is a 12 year old girl, who, when she was four, suffered an spinal cord injury in ballet dancing. I believe she was hurt by bending backwards too much without first developing the flexibility, but I am unsure of the exact cause. The doctors could not find the exact location of the spinal injury, but she currently needs crutches to walk. Dr. Chan was also unsure about the success of treating this disease, but her mother had faith in acupuncture and wanted Dr. Chan to treat her. The treatment consists of du 20, si shen cong, su 14 UB 23,25, Du 3, Ub 54, Ub 36, 40, 55, 57, 60. Front treatment is du 20, 22, yin tang, ren 4, sp 10, 9, liv 3 st 36, gb 40.

Diseases of the Prostate

Prostatitis and swollen prostate are a common diseases, some report claim that almost all men around the world will experience some form of prostatitis within their lifetime. Swollen prostate is even more common, some people say that ever man over 60 will have an enlarged prostate. Mostly, older men are effected by these conditions, however it can happen at any age.

Recently a few patients have been coming into to seek acupuncture from Dr. Chan. Their primary complaint is urinary difficultly, painful urination, dripping urination, back pain, and some report impotence. Interestingly, Dr. Chan's patients are a wide range of ages, one man was even in his 20's, the others range from 30's- 80's, with most in their 50's and 60's. One patient is 88 years old, however his promary complaint is memory loss in addition to urinary complaints. None of these men have acute prostatitis, which would probably be treated with antibiotics and herbs. Some of the men mentioned previous infections, however the others deny ever experiencing an infection.

Acupuncture treatment for prostatitis is not different from the treatment of an enlarged prostate. The treatment alternate between front and back. The front treatment is Sp6, Sp 8, Sp 9, Ren 2, 3, 4, St 28, and Kid 12 and the back treatment includes UB 54, 23, 20, 18, 17. Local warming needle can be added on Ren points and UB 23 on the back treatment. After a few weeks of treatment, 2 patients report feeling much better and can currently urinate without much difficulty. The elderly gentleman with poor memory is treated with Du 20, Si shen cong, St 36, in addition to the above points. He does not recieve bak treatments as it is difficult for him to lie on his stomach.

Another patient also complains of cold pain on the right side of the body in his joints. This is an complaint that I have only seen in China. Perhaps this is a specific description of a pain that people experience in other places, but it is remarkable how many patients here described it in exactly the same manner. For this patient, Du 20, si shen cong are added, as well as UB 57, and Ub 60. Warning needle is used on Ren points, UB 23, and UB 57 for the pain and urinary problems. Also, interestingly, warming needle has been done, with care, on Du 20. He reports feeling much better after 2 weeks of treatment, urination is improved as well as joint pain is much less.

Ramsey Hunt Syndrome and Trigeminal Neuralgia

Ramsey Hunt Syndrome is facial paralysis caused from varicella-zoster virus infection of the 7th cranial nerve. At the onset there is severe pain and inflammation around the ear, which later can lead to facial paralysis. Many of my Touro classmates should remember a case of this early on in our education.

There are two patients coming in for Ramsey hunt syndrome currently. The patients are both about 3 months post onset. Dr. Chan says in the early stages is it important to clear heat with herbs such as wu gong and ju hua, but later stage nourish the blood and open the channels. The needles focus on opening up the channel, the local ones are directed the same as the other facial paralysis cases. Needle in the direction to lift the muscle or in the direction of the disease. Points are LI4, SJ 5, LI 20, Ren 24, St 2,4, Ashi in the local area.

There are a few patients coming in with trigeminal neuralgia, a disease known for the terrible pain it causes. They are all in the chronic stage, have been treated for a number of years, just coming back for maintenance every few months. One of them is a woman in her 60's, she's had this for 3 years. She mentioned the pain a constant burning, especially on the left side, and was worse with eating spicy foods or foods with a dispersing hot nature like or fa wu. Previous her pain was unbareable, she was almost to the point of asking the doctors to help her commit suicide. She has been coming for a 3 years, and the pain is under control. She still takes occasionally takes pain killers and is afraid to stop. Points are LI4, LI 10, Tai yang, GB 20, Du 20, ST 7, si bai, St 5, LI 20, Ren 24, ashi for pain. Direct the needles tip to the pain.

Retinitis Pigmentosa

Dr. Chan is one of a few doctors at the Hunan TCM hospital who is famous for treating Retinitis Pigmentosa, in Chinese it is Shi Wang Mo Se Su Bian Xing or retina pigment changing. As the rods and cones die off in the retina, the patient develops night-blindness and a tunnel vision. As the story goes, Dr. Chan first became famous through his treatment of Chinese who spread the word of the treatment via international support groups. After that, a few Japanese patients who came to this hospital as well as European groups would come to Changsha and stay in the local hotel, coming everyday for a month for treatment.

A number of patients are coming for RP currently, interestingly all of them are young. A female who is 18 and a male in his 30's. Another patient is coming for degeneration of the optic nerve due to a motor cycle accident, but the treatment is virtually the same. He recommends a series of treatments, 2 front and followed by one back treatment. Front treatment is tai yang, xin ming (an extra point above the 1 cun above the lateral end of the eyebrow, 2 cun lateral to the end), Sp 6- san yin jiao, LI 4- he gu, GB 34, and shang ming (in the orbital, directly above the pupil). Sometimes UB 2 and St2 are added or the needles in the orbital are changed to ST 1 or UB 1. Remember to be careful when withdrawing the needle, as well as applying a lot of pressure to prevent the panda eye (black eyes). Even though, yesterday someone got a panda eye on the one side. Back treatment is tonifies the liver and gall bladder using points such as GB 37, UB 23, UB 18, and GB 20. The young girl has been coming everyday for quite a while and says she is seeing much better. More to come on the other patients.

Pediatric Encephalitis and Facial Paralysis

Dr. Chan treats a number of children for neurological conditions. A number of the children, maybe three cases, are sequela to encephalitis. One mother asked me about the treatment in the USA, I had no idea, so I needed to look it up. Apparently the USA has very little encephalitis cases, but in Southeast Asia, particularly China, encephalitis is a problem. These children most likely had Japanese Encephalitis, mosquito born viral infection, that is a significant medical issue facing China.

They come daily for treatment. Dr Chan is nice and caring, but he is not afraid of stimulating needles in baby's, who cry cry cry. Generally the treatment begins with quick body needling of PC 6, PC 8, Sp 6, and Nao qing. Sometimes back shu points of shen shu, pi shu, gan shu, ge shu are added, as well as ST 36. The he retains the needles in DU 20, 22, 24, and two vertex side lines, 1 cun lateral to center line. 3 needles each side, 3 needles for intelligence at DU 17 and lateral to it on each side, yin tang, and tai yang. After needling the baby's calm down, but they surely do scream during the needling. One cute girl is happy until she sees Dr. Chan approach and then a little frown comes out.

Two interesting cases of pediatric facial paralysis. One girl has a drooping right eyelid for 2 months. The eyelid was about 3/4 closed all the time. She is 8 years old, diagnosed with Myasthenia Gravis, a progressive degenerative muscular disease and I suspect she will have to have consistent treatment for a long time. She's doesn't like the acupuncture and cries alot, but her mother brings her everyday for a week, and already she shows improvement. She can open her eye about 3/4ths of the way open. The needles on the face should be inserted in the direction of the disease and or the direction you want to qi to go, ie. lifting the qi. Needles above the eye at UB 2, GB 14, and an Ashi above the eyebrow angled down towards the eye. Under the eye, ST 2, SI 18 angle up towards the muscle to lift the qi. Tai yang, yin tang. Needle LI 4, Gb 20, Du 20. Moxa at Du 20 and Ren 4.

Another remarkable case is a young boy, 4 years old, who fell from a 4th story window. Luckily, the only resulting injury was facial paralysis of the left side around the eye and mouth. He has also been coming for one week daily with his mother and father, who read him stories to keep him occupied. He also cries and hates acupuncture, and is also getting much better. The eye droop is almost entirely gone, but his mouth still is off centered. Local needles around the mouth to towards the mouth such as Ren 24, St 4, and ashi points, and others lifting to the nose such as LI 20, Du 26 and ashi points. LI 4, and GB 20.

TCM Secrets and a Parkinson's Case

The other day my translator and I were discussing the treatment of stroke by a very
famous doctor in the Tanjin province. Everyone all over the country knows him and people travel very far for his treatment. The students were reading a recent article of his and I asked about the content, it was about reviving patients from a recent coma. While it contained some information about the techniques, but my translator was skeptical that this doctor, or most doctors in China for that matter, divulge their real techniques. The general belief is they share the real secrets only with close relatives or senior students.

However, it may change in this generation, as the conversation then turned to how this practice has held Chinese medicine back in the last 20 years, and the reason that Western medicine has advanced so much in the recent past is their open sharing of results. Wheather it is true or not, this idea still seems to exist. Interesting thoughts, I was actually a little worried my teachers would be upset if they read my blog, giving away their secrets. Even though I think it is good PR for them, maybe it is a good thing that the blogspot website is blocked in china. (I can only post, but I cannot see my postings or the comments, send them by e-mail).

One of the most remarkable cases in Dr. Chan's clinic is a patient with Parkinson's disease. She travels to Changsha from GuangZhou for treatment once a year, this is her second series of treatments. This year when she came, had alot of difficulty making facial expressions and could not smile at all. Her legs would constantly shake on the table. Dr. Chan gives her a huge prescription, about 40 needles, even he laughs at how many their are. But after 13 treatments this month she is beginning to smile again. Her pattern is liver vacuity and wind phlegm. The head points are for the wind, but the face are for the local disease. He uses DU 20, 22, 24, yin tang, UB 4, SI 18, tai yang, St 7, St 4, St 2, Ren 24, Li 11, 10, 4, Si 6, Sp 3,6,9,10, St 34, 40, Liv 3, nao qing (an extra point for brain diseases 2 cun about ST 41 on the ST yang ming channel), and GB 34.

A New Month, A New Doctor

I just finished my rotation under Dr. Huang (not Dr he's husband, this doctor is female) and today I began with Dr Chan, the head of the acupuncture department. I will be with him for a month.

It may be a credit to Touro's education, but since I've been here, I've seen much of what we see in the states, but also some of what we have not seen that much of. The results of the common disease, which I have seen in the states, were very impressive. Especially impressive were the facial paralysis patients, many of which had results within a week or a few weeks, and then there was also one young woman with a chronic case, who have been coming for months with little results. Shoulder pain from stroke, cervical spondylosis, and hip pain all had very good reduction in pain. All of these patients came daily and received a lot of needles and moxa to open the channels. Dr. Huang is a wonderful and clear teacher. Each patient she announces the disease and the major points which are most useful for the condition. I can see how observing so many patients would give the student a certain amount of confidence, as it is drilled in your head by the end of the month. The students are ready for the next patient with the disease. But also you get a feeling for the slight changes in the prescriptions to nourish or open the channels.

The hardest to see were severe neurological diseases, especially in the children. Their families bring them everyday, hoping for any help. Before I came, I sometimes would hear about how the Chinese government would encourage abortions of disabled children and force sterilization of them (much like the USA attempted to do in the 1930's and 40's). This could be true, however the people I see are dedicated to their family members, disabled or not.

Dr. Chan is the head of the acupuncture department. Kejian and Dr. He would tell me about how the Hunan Hospital is famous for treating eye diseases, and many people from around the world, especially Japanese and European, come here for treatment of retinal degeneration or retinitis pigmentosa. Dr. Chang is the doctor who they come to see. It's pretty exciting to see these disease treated, an inch and a half needle to the hilt in the points within the orbital. Even a 2 inch needle in the extra point of chou hou (i think) lateral to St 1 at the orbital joint, which Dr. Chan says is very safe. He stresses needle technique and proper location, not just point selection. "A cun (inch) on the skin is miles beneath." Also he uses many non-channel points selections. In addition to the eye diseases, he treats many many children, but also adults, with neurological diseases. More to come on this.