A cervical pinch nerve case

Dr. David Song

Ms. Y, 45 2007-09-25

She has left hand tingling and numbness for two months, sharp burning pain for over 10 days.

The numbness appeared on the early August, tried western medicine but no effect. The pain started on the whole left arm on the early September, anti-inflammatory and painkiller didn’t work. She had X-ray at that time, reported degeneration on the C4, 5. Sept. 14 morning, the pain suddenly increased to unbearable, found nowhere to put the arm, and totally could not sleep. She been off work since last week, visited a chiropractor every day. After 3 days treatments, she felt a little better, and then it got even worse.

Now, there is burning pain on the ulnar side of left arm. No extension of the neck, hard to lie face down. No left triceps tendon reflex. The left ulnar skin is more sensitive than the right. Pulse is thin and rapid, and tongue is reddish with peeled coating in the center.

X-ray pictures showed:

C5 Luschka joints are sharp (both); C4, C5 vertebra slight moved backwards, increased C6~7 rear space; Narrow on right C4~5, C5~6, C7~T1 foramen, especially C4~5 reduced to half; narrow on left C4~5, C5~6, C7~T1foramen, C7~T1 reduced to half.

Impression: acute cervical spondylosiol (C8 never is stimulated).

After one session of acupuncture and slight Tui Na massage, the pain was reduced right away. She had 6 sessions of similar treatments, the pain on the arm was totally gone, only slight numbness on the left baby finger remained.

一例急性颈神经根炎

By Dr. David Song

Y女士，45岁 2007-09-25就诊

左手麻近两个月，疼痛十余日。

八月初出现左手麻木感，曾服西药未效。九月初开始整条左臂痛，消炎止痛药无效。摄X线提示C4、5退化。至九月十四日晨起，突加重，疼痛近至难忍，无法入睡，手臂无处摆放。上周起休息，每日看整脊医师，初三日稍减，后更重，乃来诊。

现全臂尺侧烧灼痛，颈后伸完全受限，不能俯卧，左三头肌反射未引出，余稍活跃。左手背尺侧皮肤敏感。脉细数，沉无力，舌红，中心有剥苔。

所携X线片可见：

张口位：轴突坐侧间隙稍宽，C1-2左侧侧块间隙窄，但显示不清；

正位：C5双侧钩突变尖，C6-7间隙模糊；

侧位：C4、5椎体轻度后移，C6、7后缘间隙增宽，C2、3、4曲度减小，C7、T1后凸成角；

斜位R：C4-5，C5-6，C7-T1间孔变窄，以C4-5明显，宽度缩小一半；

斜位L：C4-5，C5-6，C7-T1间孔变窄，以C4-5明显，缩小1/3，C7-T1次之，宽度缩一半。

考虑C7-T1处骨刺压迫神经或C6-7间盘刺激神经根。中医诊为阴虚火热。

治以针灸双手远端穴位，配合颈部弱电疗及轻手法推拿，一次痛减，共六次疼痛全消，仅余左小指部阵麻，临床治愈。

针推并用治疗颈痛一例

By Dr. David Song

L 女，45岁

2010-07-14就诊

颈引左肩痛十天，伴阵发头此痛，位置不定。无手麻、头晕。曾就近针灸治疗，未效。

查体：颈上段双侧肌紧张伴压痛，颈7胸1右侧肌肉紧张并高起，有压痛，左肩胛内缘条索样压痛。

印象：颈肌纤维炎。

经三次针灸配合推拿，特别行颈椎扳法后疼痛全消而愈。

Diet & Acupuncture Weight-loss

What & How to Eat During Weight-Loss by Acupuncture

By Dr. Kathryn Tian

Why do we do acupuncture to lose weight? It is because acupuncture can improve the metabolism and balance the hormone of the body. As long as the good metabolism and the normal hormone level are set up, over-weight will never happen again. During acupuncture treatment, try the following method about eating. By this method, you can lose weight while you are eating whatever you want without suffering from hunger.

Food You can Eat:

1) Protein: Boiled egg is the best. 3-5 pieces a day. One of them should be the whole while others only the white parts. You can also eat chicken without skin, lean pork, lean beef and any kinds of fish. Skim milk and plain yogurt will be perfect.

2) Vegetables： Any kinds. Broccoli, lettuce, green pepper, spinach, Galan, Bok choi, cucumber, celery and tomato are the best.

3) Fruits: Any kinds. Grapes, grapefruits, lemon, kiwi, strawberry and orange are the best.

4) Drink: Water and green tea are the best. Black coffee is OK.

Food You can not Eat：

1) Starch: Include anything having starch in it, i.e. rice, bread, noodle, macaroni and etc.

2) Sugar: Anything having sugar in it, especially the desserts.

3) Fat: All kinds of fried food, fat meat, any kinds of internal organs of animals.

4) Drink and Others: Anything having alcohol, pops, fruit juice and all kinds of fast food.

Quantity of the Three meals：

1) Breakfast: Eat until really full. You can eat proper amount of the things you actually not allowed to eat but you like so much.

2) Lunch: Eat until full. You can only eat the things that are allowed according to the above info.

3) Supper: Eat as little as possible. Eat only the things that are allowed.

Other Points for Attention:

1) Normal daily regimen is important. Sleep longer if possible.

2) Proper exercise should be walking or swimming. Avoid strenuous exercise.

In the treatment course of acupuncture, if you can eat and exercise like the above, you can usually lose 5-10 pounds in one month.

How does Tui Na Work on Lower Back Pain?

By Dr. David Song

TuiNa, also known as Chinese massage, is one of the therapeutic methods of TCM (traditional Chinese medicine), also named as AnMo (massage 按摩).

Normally Chinese people have known that TuiNa can relieve the chronic pain of the muscles and joints for over thousands years. The effects have been gradually accepted by the western world.

I. About the Orthopedic Lower Back Pain (LBP)
A. Pain comes from the muscles:
Strain, acute inflammation (sprain, attacked by cold)/myofibrositis
B. Pain comes from the joints (include ligaments, cartilage and bones):
Sprain (twisted/displaced), arthritis (rheumatoid or osteoarthritis/”Bi” syndrome), lumbar spondylolisthesis
C. Pain comes from the bones:
Osteoporosis, bone tumor
D. Pain comes from the nerves:
Protrusion of lumbar intervertebral disc (PLID), spinal canal stenosis

II. Key Points of TuiNa therapy:
A. Chronic muscle pain:
Strains, myofibrositis and myofascitis
Key symptoms and signs: stiff muscles, lower or no elasticity of the muscles, pressing pain on the surface or inside the muscles, nodes or tight strips may be found.
Pathomechanism: chronic inflammations of muscular fibers and fascia. Blongs to “muscle Bi” or Flaccidity syndrome (Wei). There is stagnations of Qi and Blood or no enough nourishment of the muscles.
Goal of the treatment: restore the elasticity of the muscles.
Key points of the manipulations: gentle manipulations are major; drawing and point pressing could be chosen when necessary in the spasm case. Drawing and point pressing may cause side effects.

B. Acute muscle pain:
Sprain, contusion, acute occurring of the chronic pain
Key symptoms and signs: sharp pain, tender spot, swelling feeling, the pain may radiate to the hip, but no shooting pain on the leg and foot, limited motion due to pain and spasm.
Pathomechanism: spasm, swelling or hematoma
Blood stasis, wind-cold-dampness
Goal of the treatment: release spasm, reduce swelling
Key points of the manipulations: combine the gentleness and toughness, local and distal. Special manipulations may be used: pressing, drawing, point pressing.
Common questions: Displaced joint or small muscle spasm;
Deep and thorough of the manipulation;
Instant cure.

C. Displacement of the joint:
Key symptoms and signs: Limited motion on certain way; blocked feeling; fixed pressing pain spot nearby the joint.
Pathomechanism: disorder of the relationship of the joint.
Goal of the treatment: adjust the joint, restore the motion.
Key points of the manipulations: Ban (turning).
The conditions of using turning method;
The functions of the turning method;
The limits and the side effects.

D. Arthritis:
Osteoarthritis and Ankylosing spondylitis.
Key symptoms and signs: chronic pain related to overuse, weather change and rest, deep pressing pain on the lumbar spine; limited motion on all directions.
Pathomechanism: damaged structure of the joints, inflammation
Combined excess and deficiency in TCM. Kidney, Liver, Blood stasis and Wind-Cold-Dampness
Goal of the treatment: stop pain, prevent the further damage on the joints
Key points of the manipulations: relax the soft tissues; drawing and vibrating; be careful on pressing and moving joints methods.

E. Protrusion of lumbar intervertebral disc (PLID):
Key symptoms and signs: shooting pain on the lower leg or foot; abnormal sense on the certain dermal segmentation; reduced strength on certain muscles; approved by CT scan or MRI.
Pathomechanism: mechanical and chemical stimulations on the nerve root; Bladder channel and Gallbladder channel; Blood stasis.
Goal of the treatment: stop pain by removing the stimulations on the nerve root; restore the nerve functions as much as we can; strengthen the lower back.
Key points of the manipulations:
Urgent stage: sharp shooting pain, not reduced during the night or lying down, SLR <>A. The difference between acupuncture and TuiNa:
Acupuncture -
Points, Easy be too strongand, Better in regulating Qi and Blood, Better in regulating organs, Stop pain as pain killer;
Tui Na -
meridians Area (big or small), Easy be gentle, Better in relaxing muscle, Better in adjusting joint, Easy be accepted.

B. What is not good for acupuncture?
Very tender and stiff muscles;
Nerve pain (Right on the pain spot);
Weak and tough muscles or tendons;
Patient who is afraid of needles.

C. How to combine acupuncture and TuiNa?
TuiNa – Acupuncture – TuiNa;
TuiNa – Acupuncture;
Acupuncture – TuiNa.
For the big tight muscle or arthritis, acupuncture can be used as the major method; for the other problems, usually use TuiNa as the major one. For electronic needling or warm needling, the effects will depend on the patient’s response.
The acupoints used in the treatments: AShi points are more useful and effective. The secret is the depth and the quantity of the stimulation.

IV. A clinical case:
♀ 46
2004-9-30
Lower back pain for 1 day.
Used to have this kind of pain once or twice a year for 10 - 15 years. Last time pain was 5 months ago. Usually relates to the weather or hard work. Also has tingling on left leg for quite a while. This time pain is more like soreness and hard to bend or straighten up the back.
Examination: Spine (-), Bend forward 10°~ 15°, backward 15°, SLR (-), reflection (-), tight muscles found on left lower back no pressing pain, L4-5, L5-S1 pressing pain (±), left side radiate to the hip.
Idea: muscle pain on the lower back.
Treatment:
1) TuiNa: pressing and point pressing on the lower back;
2) Acupuncture: left ShenShu (UB23), left DaChangShu (UB25), both L4-5 JiaJi
2004-10-7
Getting worse for the whole week, continuous pain on the lower back, especially when standing up after long time sitting. Tight muscles on the left side, L5-S1 pressing pain (+)
Treatment:
1) TuiNa: pressing;
2) Acupuncture: left ShenShu (UB23), left CiLiao (UB32), both L5-S1 JiaJi (moxa on left);
3) Ban (turn) left waist.
2004-10-14
Pain is reduced but still there. Tightness on the back of left thigh. Tight muscles on the both sides of the lower back, no pressing pain point.
Treatment:
1) TuiNa half hour: pressing, grasping and rolling;
2) Acupuncture: Both ShenShu (UB23), QiHaiShu (UB24), DaChangShu (UB25), WeiZhong (UB40)
2004-10-21
Greatly improved, still a little bit pain and tightness feeling. Tight muscles on the lower back and thigh, WeiZhong (UB40) pressing pain (+).
Treatment:
1) TuiNa: Gun (rolling)
2) Acupuncture: both ShenShu (UB23), left L4-5 JiaJi, left WeiYang (UB39)
2004-10-28
No pain, sometimes tightness feeling on the left lower back and thigh. Mild tight muscles on the left lower back, no pressing pain point.
Treatment:
1) TuiNa: on the muscles;
2) Acupuncture: left QiHaiShu (UB24), left sacral-iliac joint Ashi, left WeiZhong (UB40)

V. Final words:
TuiNa is an useful method in lower back problems. Combining with acupuncture, TuiNa can make very good effects. The key points of this therapy are:
1) Combine the meridian therapy and modern anatomy together to find out the exact problem area;
2) Find out the quantity of the stimulation which fits the certain patient;
3) Well trained TuiNa and acupuncture skill.