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Clinical Pearls
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Medical Acupuncture is pleased to continue this new regular feature, Clinical Pearls, which we trust will be useful to
the readership. All of us are confronted with clinical challenges, especially when dealing with therapeutic strategies. We
hope you will find this ongoing collection of Clinical Pearls at your fingertips, ready to put into action for the benefit of
our patients—and even ourselves. How often do we ask our colleagues, “How do you treat. . . ?” To continue this new
endeavor, we posed the question: “How do you treat fibromyalgia in your practice?” Here are the “Pearls” we received.
We trust that the readership will participate in this section by either asking the questions or supplying the “Pearls.” We
welcome your input. Please address your “Pearls” to our Managing Editor at RosalynR@aol.com.
141
142 CLINICAL PEARLS
30 minutes twice a week at the patient’s own pace, and to Xiangya Hospital
breathe deeply and perform mental relaxation exercises for Central South University
another 30 minutes. I also recommend to patients that he/she Changsha, 410008
perform twice-weekly stretching exercises involving the China
paraspinalis muscles, glutei, hamstrings, ankle plantar flex-
ors, and hip flexors. E-mail: jtfeng1976@hotmail.com
I also perform acupuncture: usually 20 sessions, twice
weekly for 20 minutes each. I use disposable, sterilized, flex-
ible stainless steel 0.25mm 40mm needles at these clas-
sical acupuncture points: Ex-HN-3, and bilateral LR 3,
F IBROMYALGIA IS A SYNDROME that could refer to a vari-
ety of Chinese Medicine (CM) energy states ranging
from Deficiency/Stagnation to excess Damp/Heat accumu-
LI 4, PC 6, GB 34, and SP 6 points. Needle penetration is lation. Assuming the more common scenario of a Blood and
10–30 mm with or without extra rotational or manual stim- Qi Deficiency with pain and fatigue, then one of the sim-
ulation after needle insertion. Depth of needle penetration is plest protocols I have found originated from the Shanghai
determined by the patient’s sensitivity until Qi is obtained. School of TCM and was adapted as a protocol for chronic
The inclination of the needle is 90° in all points except for
Medical Acupuncture 2008.20:141-145.
2. Flaws B. Fibromyalgia syndrome and Chinese herbal medicine. 2. Martin DP, Sletten CD, Williams BA, Berger IH. Improvement
Townsend Letter for Doctors. Feb–Mar 2004. http://findarticles. in fibromyalgia symptoms with acupuncture: results of a ran-
com/p/articles/mi_m0ISW/is_247-248/ai_113807047/pg_1. domised control trial. Mayo Clin Proc. 2006;81(6):749–757.
Accessed April 19, 2008. 3. Wang ZY. Electroacupuncture. In: Qiu P-R, Cheng H-P, eds.
3. Wight A. Fibromyalgia; recommend USANA. http://news- New Editorial Chinese Acupuncture and Moxibustion. Shang-
groups.derkeiler.com/Archive/Alt/alt.med.fibromyalgia/2005- hai, China: Shanghai Science & Technology Publisher; 1992.
11/msg00200.html. Posted November 2005. Accessed April 19,
Edwin Yong Miao
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2008.
M. Modern Traditional Chinese Medical Clinic
Michael T. Greenwood, MD, (MB), BCHIR,FCFP, 52 (Part 2) Pitt Street
CAFCI, FAAMA, FRSA Ringwood
Victoria Pain Clinic Victoria 3134
103-284 Helmcken Road Australia
Victoria, BC, V9B 1T2
Canada E-mail: edwinmiao2@optusnet.com.au
E-mail: michaeltgreenwood@shaw.ca
M Y PROTOCOL FOR TREATING
includes:
patients with fibromyalgia
• Ying Tang and GV 20 on the head • Restrict caffeine, sugars, and alcohol.
• MH 6, LR 2 and 3, LI 4 and 11, TH 5, HT 3 or 7, plus
CV 17 and 14, as well as Kidney tonification points, e.g., Stephen S. Rodrigues, MD
KI 3 or 7. 5445 La Sierra Drive, Suite 102
Dallas, TX 75231
Moxa to the deficient points seems very soothing to pa-
tients. I tend to avoid electrical stimulation in these patients. E-mail: drstephenrodrigues@msn.co
If a traumatic event preceded the onset, I also use the
Seven Dragons (Internal or External or both, at separate
treatments).
Linda J. Lemay, MD
A CUPUNCTURE HAS BEEN SHOWN to be an efficient way to
treat fibromyalgia.1 Acupuncture is an increasingly ac-
cepted method used by physicians as a way to provide fi-
3566 Pompey Hollow Road bromyalgia patients with a non-chemical antalgic. Symp-
Cazenovia, NY 13035 toms such as a prolonged dull ache or sharp pain can be
resolved dramatically by inserting and manipulating a few
Medical Acupuncture 2008.20:141-145.
Similarly, pain on the inferior portion of the line can be would calm down soon after needle retaining. A desirable
treated with points on the superior portion, i.e., toe pain relief will come after withdrawing the needles.
could be relieved by an acupoint around the outer can- Crossing point selecting uses neither the point in situ nor
thus; a shoulder acupoint will work on a pain around the along the involving channel. The position of the selected
lateral ankle region, and so on. The key to this method is point is always on the opposite side of the original pain point,
that you have to seek a corresponding area of tenderness and is corresponsive to the pain point locationally. It is ap-
and stiffness near the point you choose to needle. As a plied for a pain that could not be punctured in situ because
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rule of thumb, if the point is close to a regular acupoint, of the pain point being extrasensitive. A good example is
choose the latter; if not, then use the point that is most pain and stiffness around the anus, which could be treated
tender and reactive. by needling GV 20 on the vertex. This reflects a typical cor-
• The second method is called the “Neck Eight Points” responding relation between top and bottom. Furthermore,
method. In Chinese pinyin, it is “Chi Zi Mai,” and these the point sitting on the lower lip, CV 24, could respond to
points are similar to Sky-Window points. These 8 points a rigid neck pain on the posterior middle line. It suggests a
comprise a set of points on each of the 6 Yang channels, corresponsive pair of front and back. Commonly, if a se-
Conceive Vessel (CV), and Governor Vessel (GV), re- lected point is close to a trigger point or a tender point, the
spectively. Structurally, all Yang channels will converge latter should be used.
to the head from the extremities and the neck is the ex-
clusive passgate. In addition, 6 neck points are where 12 Rule 3. Holistic regulation in pain. According to the idea of
divergent channels are converged. Those distinct struc- holistic view, there is a mutual inductive relationship between
tures endue the neck point’s expansive capabilities on pain internal organs and exterior of the body. As a rule of treat-
relief. It differs from the foregoing line-seat method ment, acupoint selection should reflect the relation between
merely on antilogous channel regulating; furthermore, the exterior and interior body as a whole. In practice, it is com-
Medical Acupuncture 2008.20:141-145.
neck points could treat a pain involving both exterior and mon to treat a pain in an internal organ with acupoints on ex-
interior channels. In the clinic, neck points could be used tremes. Conversely, a pain on extremes could be alleviated by
in suppressing various somatic pains, especially a dull points on the torso. For example, upper scapular rigidity might
ache, fractious sore or strain, and pain. For example, if couple with coldness on the lower abdomen, which can be as-
pain is on the radial side of the forearm, sitting on the suaged by moxibustion on CV 3. For an ache around the un-
Hand Taiyang compartment, LI 18 is the best acupoint to lar side olecranon, Hand Taiyang Small Intestine channel, one
puncture. If the pain or rigidity appears on the Foot might find the tender point around Heart Shu or Shen Dao
Taiyang region, like the groin or frontal thigh, ST 9 should CV 11. It is clear that regulating internal organs could be a
be used. Pain on the hip or lateral thigh could be stopped desirable way to repress the pain on the exterior of body. Un-
by selecting SI 17. In most cases, a pain would disappear der the guidance of traditional channel theory, one could find
without being noticed. It is not necessary to pursue a dis- more corresponsive connection between exterior pain and in-
tinct needle reaction here because of possible injuries of ternal organs. Traditional Mu points might be useful in se-
the carotid vessel or nervous trunks. lecting points for pain on relevant regions.
A typical prescription in acupoint selecting for fi-
Rule 2. Select an acupoint on the pain point. This rule pro- bromyalgia should integrate all 3 point-selecting rules fore-
vides a geographic acupoint selecting method. It has 2 meth- going. However, for some cases, not all 3 rules need to be
ods to it—situ point selecting and crossing point selecting. applied.
Puncturing in situ is the most commonly used method in
acupuncture. One should puncture a needle at the irritated
point. Generally, it seems hard to locate a deep-seated pain REFERENCE
point distinctly, because pain points tend to sit deeply un-
der the skin, but one should at least try to get a rough idea 1. Duncan B, Langhorst J, et al. Acupuncture in the treatment of
of its location. The position of pain refers not only to a bidi- fibromyalgia in tertiary care—a case series. Acup Med.
mentional landmark on the skin, but also to the depth un- 2007;25(4):137–147.
derneath the skin. The latter could determine how deep the He Chong, PhD
needles should go under the skin. A distinct needle reaction 309 South Park Way, Lewis 205
should be sought because it will indicate whether the nee- Broomal, PA 19008
dle has touched the focus. Usually, it would cause an in-
creased but bearable tenderness around the pain point, but E-mail: hechongbox@gmail.com