Monday, September 30, 2013

Handouts for October 3rd 2013 Webinar on Treating Pain

Get Better Results When Treating Pain
with Honora Lee Wolfe
Copyright, 2013

THE Basic Statement About Pain
Where there is free flow, there is no pain;
 where there is pain, there is no free flow.

Most Common Patterns Associated with Pain
1.Qi stagnation in the local area
2. Blood stasis in the local area
3. Qi & blood vacuity leading to the lack of nourishment of the sinews & vessels
4. Damp or damp heat inhibiting the flow of qi & blood to and through the sinews and vessels
5. Yang vacuity leading to cold congelation and    blood stasis in the channels & sinews

When treating pain/disease with acupuncture and herbal formulas together one should...
Combine root tx with branch tx for the best results.
• Root tx are based on viscera & bowel; qi & blood; fluids & humors; yin & yang pattern discrimination. (often herbal)
• Branch tx are channel-based, based on channel & network vessel pattern discr. and on palpation. (often acu-moxa)

In Chinese medicine in general,
…all treatment methods can be divided into Bu fa and Xie fa

Bu fa means supplementing methods
Xie fa means draining methods

Best General Acupoints for Pain
LI 11 for all upper body pain (with LI 4 for more power.)
UB 60 & GB 34 for all lower body pain
Add Xi (Cleft) points for more power; add electricity, as strong as the person can handle, on these.
Four Bars for head, neck, torso pain.
Related specific ear points.
Bodywork & Pain
In cases of blood stasis or recent trauma, deep tissue work at the site of the pain is often counter-productive.
Bodywork distal to the injury can be helpful to open the channels and free the flow of qi and blood.
Lighter bodywork on an injury after major healing has occurred is useful.
Bodywork in conjunction with moxa on old injuries may be quite helpful.
Use liniments with these treatments for best results!
Acupoint selection
§For moxibustion, use mostly ah-shi points in trauma conditions
§When using moxa as your local or branch treatment, you might choose tender points on related channels as your root treatment
§E.g., for right side shoulder pain on the yang ming channel, moxa ah-shi points in the area of LI 15, needle the same points on the opposite side, and use thread moxa or gold needles on relevant points foot yang ming and foot tai yin as a root treatment.
Bleeding in pain cases
1. Fever (replete yang, not yin vacuity type) (i.e., full, fast pulse, red tongue, full/replete heat symptoms)
2. Sore throat  (replete yang, wind heat common cold or flu, not vacuity symptoms)
3. Musculoskeletal pain which is stabbing or biting, site specific, and recurrent
4. Musculoskeletal pain which is dull and constant but worse with movement
5. Headaches or eye pain of a replete yang nature
6. Itching
7. To reduce swelling caused by stasis of blood and stagnation of qi
8. Numbness or pain with numbness
9. Vomiting caused by stomach heat
10. Emergency resuscitation
11. When there are clear signs of blood stasis such as varicosities or spider nevi veins, especially for pain conditions on the same channel
External therapies
§Pastes & plasters (gao)
§Wines (jiu) or tinctures (ding ji)
§Powders (fen)
§Oils (you)
§Washes (shui fen)
§Compresses (shi fu)
§Medicinal baths (yao yu)
§Fumigation (yan xun liao fa)

External therapies for pain from Blue Poppy

Shao Lin Dee Dat Jow
§Radix Angelicae Sinensis (Dang Gui)
§Radix Ligustici Wallichii (Chuan Xiong)
§Radix Cyathulae (Chuan Niu Xi)
§Lignum Sappanis (Su Mu)
§Flos Carthami Tinctorii (Hong Hua)
§Flos Caryophylli (Ding Xiang)
§Radix Auklandiae Lappae (Mu Xiang)
§Resina Olibani (Ru Xiang)
§Lignum Santali Albi (Bai Tan Xiang)
§Fructus Foeniculi Vulgaris (Xiao Hui Xiang)
§Moves the qi & quickens the blood
§Disperses swelling & stops pain
Indications: Recent closed injuries with swelling and pain     
External Therapies: Dragon’s Blood
§Sanguis Draconis (Xue Jie)
§Lignum Pini Nodi (Song Jie)
§Resina Olibani (Ru Xiang)
§Resina Myrrhae (Mo Yao)
§Radix Et Rhizoma Rhei (Da Huang)
§Flos Carthami Tinctorii (Hong Hua)
§Lignum Sappanis (Su Mu)
§Radix Pseudoginseng (San Qi)
§Camphora (Zhang Nao)
§Borneolum (Bing Pian)
§Quickens the blood & dispels stasis
§Disperses swelling & stops pain
Indications: Recent closed injuries with marked ecchymosis

External therapies: Green Willow Liniment
§Flos Carthami Tinctorii (Hong Hua)
§Radix Aconiti Carmichaeli (Chuan Wu)
§Radix Aconiti Kusnezoffii (Cao Wu)
§Radix Angelicae Sinensis (Dang Gui)
§Semen Pruni Persicae (Tao Ren)
§Herba Ephedrae (Ma Huang)
§Pyritum (Zi Ran Tong)
§Semen Strychnotis (Ma Qian Zi)
§Ramulus Cinnamomi Cassiae (Gui Zi)
§Radix Auklandiae Lappae (Mu Xiang)
§Resina Myrrhae (Mo Yao)
§uncooked Rhizoma Zingiberis (Sheng Jiang)
§Moves the qi & quickens the blood
§Warms the channels & frees the flow of impediment
Indications: Wind cold damp impediment

External therapies: Three Angels Liniment
§Cortex Phellodendri (Huang Bai)
§Rhizoma Atractylodis (Cang Zhu)
§Radix Achyranthis Bidentatae (Niu Xi)
§Caulis Trachelospermi (Luo Shi Teng)
§Caulis Lonicerae Japonicae (Ren Dong Teng)
§Radix Angelicae Dahuricae (Bai Zhi)
§Radix Angelicae Pubescentis (Du Huo)
§Radix Angelicae Sinensis (Dang Gui)
§Radix Et Rhizoma Rhei (Da Huang)
§Camphora (Zhang Nao)
§Borneolum (Bing Pian)
§Clears heat & eliminates dampness
§Frees the flow of impediment & stops pain
Indications: Wind damp heat impediment

External therapies: Sprain Ointment
§Radix Et Rhizoma Rhei (Da Huang)
§Herba Lycopi Lucidi (Ze Lan)
§Lumbricus (Di Long)
§Fructus Gardeniae Jasminoidis (Zhi Zi)
§Pasta Acaciae Catechu (Er Cha)
§Resina Olibani (Ru Xiang)
§Borneolum (Bing Pian)
§Sesame oil
§Quickens the blood and dispels stasis
§Clears heat, disperses swelling & stops pain
Indications: Recent sprain or closed injury characterized by redness, heat, swelling, and pain

External therapies: Stop Pain Tincture
§Flos Carthami Tinctorii (Hong Hua)
§Rhizoma Nardostachydis (Gan Song Xiang)
Functions: Moves the qi, quickens the blood, stops pain
Indications: For the symptomatic relief of any pain

External Therapy:
1. Herbal Sports Massage Oil
Moves qi and quickens the blood to stop pain in sports injuries

2. Dr. Bob’s Oil and Pain Stick
Same formula as Po Sum On with peppermint and cinnamon essential oils, for temporary relief of muscle pain

Internal Formulas: Kidney Mansion Formula
Shu Di, Shan Zhu Yu, Gou Qi Zi, Tu Si Zi, Du Zhong, Xu Duan, Bu Gu Zhi, Ba Ji Tian, Niu Xi, Gu Sui Bu, Wu Jia Pi, Dang Gui, Chi Shao, Chuan Xiong, Ren Shen
Tx Patterns: liver-kidney vacuity with  blood stasis and wind damp evils.
Tx Conditions: Chronic low back pain, post-menopausal osteoporosis
For mostly aging patients with chronic low back pain.

Internal Formulas: Impediment Magic Formula
Yi yi ren, Qiang huo, Niu xi, Cang zhu, Mu gua, Xiang fu, Wu yao, Fang ji, Qin jiao, Dang gui, Ru xiang, Mo yao, Tao ren, Hong hua, Di long, Gui zhi, Su gen, Gan cao
Tx Principles: Dispels wind, scatters cold, and eliminates dampness, quickens the blood, frees the flow of the network vessels, and stops pain
Tx Conditions: For chronic, enduring bi due to wind, cold, damp and blood stasis in the network vessels.
For long term use, you may need to add something more to help the formula be more easily digested

Internal Formulas: Dang Gui & Anemarrhena Formula
Dan gui, Dang shen, Bai zhi, Cang zhu, Zhu ling, Ze xie, Zhi mu, Huang qin, Yin chen hao, Ku shen, Ge gen, Qiang huo, Fang feng, Sheng ma, Gan cao.
Tx Patterns: For wind damp heat bi with spleen qi vacuity and liver qi
Tx Conditions: This pattern combination is often seen in rheumatoid arthritis, lupus eryth., fibromylagia, and chronic fatigue (CFIDS)
The dampness here is internally engendered due to spleen deficiency

Experiential Tidbits:           
1. With scar therapy, check which direction of applied pressure on the scar makes the related pain worse or better and insert needles in the direction that makes the pain better. Then go over the scar with a Tiger warmer.
2. Bleed an ear point for immediate pain relief. Any related ear point can be used; find one that is sore.
3. Acute Ankle Sprain - bleed point of worst pain; needle same spot on opposite side with deep, Chinese style needling.
4. Check for vascular spiders around the tail bone and sacrum if there is chronic sciatica, piriformis syndrome, neck tension, or back pain.  If you find them, bleed them.
5. For chronic chest pain where blood stasis plays a role, use Ion Pumping cords with black clip on Per 6 and red clip on GB 34 or Sp 4, whichever is more tender.
6. For chronic one-side low back pain, use Black clip on Bl 23 and Red clip on GB 29 or 34, whichever is more tender. Try the same side first and recheck painful spots. Switch to unaffected side if the painful spots do not improve.
7. Chronic Sciatica - Black Clip on GB 30, Red clip on Ki 1 or Bl 60, Green clip on a point 1 cun lateral to Bl 40. On GB 30 use a long needle Chinese style inserted in the direction that the pain shoots. Must insert needle at the same angle that the pressure elicits pain. Spark the black needle every five minutes...leave all needles for 20 minutes. Add moxa at the end of the treatment.

What to try if treatments are unsuccessful
1. Akabane testing/stimulation
2. Ear needles
3. If there are any purple/black veins, if there has been surgery, or if the pain is fixed and stabbing, consider bleeding one or two points
4. Pay more attention to treating the root.
5. Reexamine the patient’s pulse and tongue and go back over what questions you asked to see if you overlooked any factors that may contribute to the condition.
6. Go over self-care techniques with the patient if you have not already done so.
7. Find out if their work habits have changed or if their work-related stress levels have worsened.
8. Suggest dietary changes to support your root treatment.

And finally….
Combining root therapies with branch therapies always gets better results.
Using external and internal herbals together with your acu-moxa treatments is usually more effective than either one alone in pain conditions.

Good Luck and Best Wishes for Success!


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