DEAR READER: The carpal tunnel is literally a passageway on each palm side of the wrist that protects the main nerve to the hand and accompanying tendons responsible for allowing the fingers to bend. The syndrome occurs when pressure is placed on the median nerve, causing pain, tingling, numbness and eventual weakness of the affected hand. Repetitive motion for extended periods of time, such as swinging a hammer, and diabetes, rheumatoid arthritis, some thyroid problems and amyloid deposits are a few of the possible causes. Amyloid is an abnormal protein manufactured in bone marrow. Symptoms of the syndrome typically begin slowly but can progress to the stage at which a physician should be consulted.

Confirmation might be made by an electromyography or through a nerve-conduction study.

Initial nonsurgical control for mild nerve impairment might include a wrist splint, over-the-counter nonsteroidal anti-inflammatory drugs, supplemental vitamin B6 or a cortisone injection. Chiropractic therapy, acupuncture, yoga and a number of similar techniques for relaxation might also be appropriate. When conservative measures fail to produce positive results, surgery might follow. That decision is best left to you and your primary-care physician or specialist.

Chiropractic therapy is therapeutic manipulation of the spinal column and deep muscle massage that does not involve the use of drugs or surgery. It is performed by a qualified chiropractic doctor and based on the theory that a person’s health is determined by the condition of the musculoskeletal and nervous systems.

Acupuncture involves the ancient practice of inserting thin needles into the skin at strategic points throughout the body for relief from pain. Treatment plans commonly involve from six to 12 sessions over a period of a few months. Up to 20 needles will be used in a single treatment and will remain in place for up to 30 minutes.

Yoga is yet another ancient practice that combines relaxation and exercise to provide pain relief. Simply put, a person controls his or her breathing while going through a series of specific movements.

Tai chi has developed over the years into a gentle form of exercise aimed at reducing stress and anxiety. This Chinese art is known to help with a variety of health disorders.

If you are experiencing a return of symptoms, return to your acupuncturist for periodic maintenance, which is often found to be beneficial.

It goes without saying that if you perform repetitive motion in your line of work or at home, modify the practice as much as possible. Be sure to take frequent five- to 10-minute breaks to allow your hands to rest while performing these actions.

To provide related information, I am sending you a copy of my Health Report “Managing Chronic Pain.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.

Fibromyalgia is a medically unexplained syndrome characterized by chronic widespread pain, a heightened and painful response to pressure, insomnia, fatigue, and depression. While not all affected persons experience all associated symptoms, the following symptoms commonly occur together:

chronic pain
debilitating fatigue
difficulty sleeping
anxiety and depression
joint stiffness
chronic headaches and jaw pain
difficulty swallowing
dryness in mouth, nose, and eyes
hypersensitivity to odors, bright lights, and loud noises
inability to concentrate
irritable bowel syndrome
numbness or tingling in the fingers and feet
painful menstrual cramps
poor circulation in hands and feet.
restless legs syndrome

Fibromyalgia is diagnosed when there is a history of widespread pain in all four quadrants of the body for a minimum duration of three months and pain when pressure is applied to at least 11 of 18 designated tender points on the body. This condition does not result in any physical damage to the body or its tissues and there are no laboratory tests which can confirm this diagnosis.

Symptoms often begin after a physical or emotional trauma, but in many cases there appears to be no triggering event. Women are more prone to develop the disorder than are men, and the risk of fibromyalgia increases with age.

The Chinese medical theory of pain is expressed in this famous Chinese saying: “free flow of QI= no pain, no free flow of QI= pain.”

Pain is seen as a disruption of the free flow of Qi within the body. The disruption of Qi that results in fibromyalgia is usually associated with disharmonies of the “Liver” median.

You can reduce your symptoms significantly by incorporating a few simple life-style changes into your daily routines and habits.

1. Eliminate processed foods from your diet, especially white sugar and white flour products. These products give our bodies little nutrition and over time can damage our digestion.
2. Include all unprocessed foods in your diet, such as proteins, complex and unrefined carbohydrates, vegetables, whole grains and legumes .
3. Avoid overly greasy foods, ice cold drinks, alcohol, raw and uncooked foods, hot, peppery foods, coffee, and too much fruit. Avoid daily juice drinks since these are the same as eating a candy bar in the amount of sugar introduced into the body.
4. Do not drink sodas. Sodas are acidic in nature and are loaded with sugar and chemicals. Sodas are detrimental to both the spleen and the kidneys.
5. Find some type of exercise that you really enjoy and just do it. You would probably benefit most from some kind of cardiovascular exercise to keep to blood moving, such as swimming, yoga, stretching, and bicycling.
6. Take a walk every day. If you live with a dog or cat, play with them daily. Animals live in the moment and love to play. This is a great way to break stressful daily routines.
7. Buy some relaxation tapes with guided imaging. Learn how to really relax. This means bodily relaxation as well as mental repose. Use these tapes daily for the best results.
8. If you know that you have too much stress in your life, then find a solution. This may be finding a new job or new, more supportive relationships. Understand that stress alone can kill you, and if you smoke and consume alcohol to escape stressful situations, you are only fooling yourself.
9. Find a Chinese medical practitioner who can help you maintain good health with Chinese medicinal herbs and acupuncture. If you visit with a practitioner on a regular basis, before you become ill, then you avoid many other more serious problems later. Remember that the strong suit of Traditional Chinese Medicine is prevention.

Alan Rivenson, L.Ac, Dipl in Acupuncture
Affordable Acupuncture
25 Main Street
Canaan CT 06018
860-824-7727
arivenson@att.net

IBS is described as a ‘functional’ illness — the small and large intestines are not functioning appropriately although there is no structural damage found through diagnostic testing. No anatomic defect can be found in IBS patients, and the cause of the illness is not known. What is known is that there is a link between the onset of symptoms and emotional triggers. There are two major clinical types of IBS described in Western medicine: diarrhea-predominant IBS and constipation-predominant IBS. Diarrhea-predominant IBS is characterized by diarrhea, which occurs immediately after waking up or immediately after eating. Other common symptoms include pain, bloating, urgency, and urinary incontinence. Constipation-predominant (or ‘spastic colon’ type) IBS manifests with pain over at least one area of the colon and periodic constipation. This pain may be continuous or it may come in bouts, and is frequently relieved by moving the bowels. There may be constipation alternating with normal stools or constipation alternating with diarrhea. The stool often contains mucus. Associated symptoms include bloating, gas, nausea and dyspepsia. Eating can commonly trigger these symptoms. Western medicine treats IBS with anti-spasmodic or anti-diarrhea medication, diet modification and stress reduction techniques.

Traditional Chinese Medicine (TCM) is a medical system which combines the use of acupuncture, Chinese herbs, and nutrition to bring the body into balance. Whereas Western medicine looks closely at a symptom and tries to find an underlying cause, TCM looks at the body as a whole. Each symptom is looked at in relationship to all other presenting symptoms. The goal of the TCM practitioner is to assess the entire constitution of the patient — considering both physiological and psychological aspects. The practitioner first observes the general characteristics of the patient, and then tries to discern a relationship between symptoms in order to establish what is called a “pattern of disharmony.”

To look at the body as an integrated whole, one also looks at the theory of the ‘Internal Organs.’ The TCM definition of an Internal Organ is very different from the Western concept. In Western medicine, an organ is a material-anatomical structure. In Chinese medicine, each Internal Organ encompasses much more. There can be an anatomical structure, but there is also a corresponding emotion, tissue, sensory organ, color, and element. In addition, twelve of the Internal Organs correspond to the twelve main acupuncture meridians that run through the body. There is energy (Qi) flowing through each meridian. If an Internal Organ is out of balance, the energy of that organ will be damaged. IBS affects the large and small intestines in Western medicine, but in Chinese theory, the Spleen, Liver, Kidney, and Large Intestine can all play a role in the pattern of disharmony.

In TCM, the Spleen is considered to be the key organ to regulate digestion. Keep in mind; this is not the same as the Western spleen. Its functions actually have a closer connection to the Western pancreas. IBS patients with a pattern of Spleen Qi deficiency will suffer from fatigue and diarrhea, which becomes worse when they are overexerting themselves. This is often accompanied by abdominal pain, which may be relieved by exerting pressure over the painful area. Patients may also have gas and bloating. Hemorrhoids are an additional indication of Spleen Qi deficiency. Acupuncture points are chosen which will help nourish the Spleen Qi. There are also specific techniques used in needling that strengthen the body when the patient is deficient. Another important part of treatment is the Chinese herbal formula. In Chinese herbalism, a group of herbs is combined together to specifically address a person’s unique constitution. This is one way in which treatment is very individualized — a master herbalist treats no two patients with the same combination of herbs. Most herbalists use a “classical formula” as a foundation. Many classical formulas written up to 2,000 years ago are still commonly used today. Groups of herbs can be added or taken out of classical formulas on order to customize them for patients. One classical formula used for Spleen Qi deficiency is called Bu Zhong Yi Qi Tang (Ginseng and Astragalus Combination). By adding and subtracting herbs from this formula, it can be individualized to fit the precise needs of the patient.

Another pattern is Spleen Distressed by Dampness. In this pattern the patient may experience symptoms of nausea or heaviness. Bowel movements may feel incomplete, or the patient may even have constipation lined with mucus. This condition is often caused by eating too much fried or greasy food, but may also be caused by emotional factors such as over-thinking or over-worrying. Acupuncture points are chosen to nourish the Spleen and eliminate dampness. The classical herbal formula to address this pattern is called Shen Ling Bai Zhu San (Ginseng, Poria & Atractylodes Powder). Patients are additionally advised to keep a very clean diet. In Chinese medicine, dairy foods and excessive sugar intake create dampness, so these foods should be avoided altogether.

Other patterns include “Cold in the Spleen”, “Spleen and Kidney Yang Deficiency”, “Liver Qi Stagnation”, and “Damp-Heat in the Large Intestine”,

Irritable Bowel Syndrome is clearly a complicated illness in both Western and Chinese medicine. Its many manifestations require very different treatment approaches in Traditional Chinese Medicine. The patterns of disharmony mentioned above may even appear in combination and treatment must be adjusted appropriately. In any severe case of IBS, TCM treatment will be customized for the individual and classical herbal formulas will be modified for the patient.

An Australian study published in 1998 in the Journal of the American Medical Association lends strong scientific support to treating IBS with Chinese herbs. In this double-blind study, 116 patients with IBS were divided into three groups. One group was given a standard Chinese herbal preparation, a second group was given customized herbal formulas individually written for each patient, and a third group was given a placebo. Each patient had regular consultations with both a Chinese herbal-medicine practitioner and a gastroenterologist. Both groups taking the Chinese herbs showed significant improvement over the patients taking the placebo. Positive results were reported by both the patients themselves and the gastroenterologists. Although there was improvement in both groups of patients taking herbs, it is important to note that the positive effects were shown to last longer in the group that was given individualized formulas. This study clearly shows that Chinese herbalism is most effective when each patient is treated not only for their condition, but also for their bodily constitution and other presenting symptoms.

Alan Rivenson, L.Ac., Dipl. Ac.
Affordable Acupuncture
PO Box 298, Canaan, CT 06018
860-824-7727
ARivenson@att.net
www.BerkshireQi.com

DEAR READER:
When I received your letter, I was quite taken back by your rudeness. I have chosen to print your letter exactly as I received it to show my readers what some of my more “interesting” mail looks like.

If you are really in school to become an acupuncturist, perhaps you should learn to spell your desired profession first. I may not believe acupuncture is a cure-all, but I am willing to accept that it can work wonders for some individuals.

I would also like to comment on your claim that you work in an emergency room. I sincerely hope you do not have direct patient contact. I assume you work behind a desk, take more care to properly spell and punctuate while at work, but even that is somewhat frightening.

Now to the article you enclosed regarding my comments on acupuncture. To the best of my knowledge there is no hard scientific proof that acupuncture can cure any disease. I do not recommend against acupuncture but rather say that it should be considered once a proper diagnosis has been made. It can certainly be used alongside modern medicine but I don’t believe it should be relied on as a sole treatment until other options have been exhausted.

I would welcome comments from both the modern and alternative medicine communities regarding my recommendations. Fanatics need not write. I am looking for intelligent, dignified responses. Medical doctors, who also have training in alternative treatments, please write to tell me about your experiences with both schools of thought.

Would acupuncture be an effective treatment or at least worth a try in your opinion, or are my thoughts misdirected?

DEAR READER: If you are in pain, this alternative form of therapy might help, but acupuncture is not ordinarily a consideration for treatment of arterial blockage (stenosis) or heart disease. Without knowing more about you, I can only recommend you speak with your primary care physician or cardiologist. They both should have your complete medical history and can better direct you.